HomeMy WebLinkAbout4906 DAKOTA DR - APPLICATIONS - 5/6/2014APR/15/2014/TUE 09:44 AM Delta Mechanical Inc
FAX No.866-692-5275
P, 002
City of
Fort Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 60524
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
p Ventilation :(Water Heater 0 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 # Date 201,+-
For oHlce use only
Job Site Address (required) Value of Construction (labor, materials, profit)
y90 PAk'F0 17r. bS2 C)
Property wner Nam Address Clty/State Zip Phone
�,,� J u L is e 4 SUS'
A plicant N e Address city/State Zip Phone
Y 04Z+k.,<S Samea6belomi
o10t� Address City/State ZIP Phone
bbt%Ef0n�15�v0. GSA �� 35206 �fcb 1�1�i.5a"13
Contractor City of Ft, Collins Sales Tax # Are you paying taxes here or by report? 7Herre ❑ Report
Sales H-b ynungfecurredayal/mniracmrs. Are you paying with your trust account? [des ClNo
�FZu6t
Is this a residential or commercial project? Residential ❑ Commercial
If residential, Is It: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
O Multifamily (apartment) LI Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (ex lain)
Is this building 50 years of age or more? Cl Yes �$!No If yes, you may need to contactHistoric preseruat/on
If this is for a demolition permit, what year was t building constructed?
ff prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work W Ot-+CFz- ilPiGR— 0 4
*If lawn sprinkler/backflow preventer, must list licensed plumber. IF First-time A/C, must list licensed electrician.
Subcontractors: La the company name or City ofFt Collins license #
Vectr:cian Plumber Mechanical Roofer Other
1 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: �j nrt11 ,I�Lt Print Name:"^ ry` 1 Signature4 W Date �t5 —'