HomeMy WebLinkAbout2031 Derby Ct - Applications/Furnace - 12/31/2013Dec 30 2013 04:52PM HP Fax
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Fort Collins
Planning, Development A Transportation
281 N: College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # 30(,¢Fi01 Date Tee. %�• Zbl3
For office use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
2031 Derby Court
$4,200.00
Property Owner Name Address
City/State Zip
Phone
Quinn Lods 2031 Derby Court
Fort Collins, CO 80526
970-215-1673
Applicant Name Address
City/State Zip
Phone
Albrachrs One Hour Heating & Air 487 Denver Avenue Loveland, CO 80537
970-663-4002
Contractor Address
city/State Zip
Phone
Albracht's One Hour Heating & Air 487 Denver Avenue Loveland, CO 80537
970-663-4002
Contractor City of FL Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here f9 Report
Sales tax number Is required by allcontradars.
Are you paying with your trust account?
IR Yes ❑ No
Is this a residential or commercial project? El Residential ❑ Commercial
If residential, is it: ® Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Muftifamiiy (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explaln)
Is this building 50 years of age or more? ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
I "?rlor to 1975, you will need an asbestos assessment to submit with this application.
Description of work Replace 70K BTU furnace
*If lawn sprinklerlbaddlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: Ust the company name or Gty of Ft Collins 11cense #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and Correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant, Stacey Schmidt S .chit: *
Print Name: Signature
Date 12/30/2013