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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 —'