HomeMy WebLinkAbout4900 DAKOTA DR - APPLICATIONS - 9/21/2018010'r0# Planning, Development, & Transportation Services
Fort Collins Community Development & Neighborhood Services
r^ 281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax 970.224.6134
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 # iONL g �
Forofce use only
Date ?'.? i - /Y
Sob Site A�dress (required) Value of Construction (labor, materials, profit)
4%Oo LAroTA N? CO dS2 8' /9 ,/ �2 S r-z;,zY
Property Owner Name Address City/State Tip Phone
Ez1Z1413e+N r3ERG-dvrsT 5/5700 lia�'o."�r12 faa; C�azc�,r5 ee 9'4a'z� 970-.215--e62'
Applicant Name Address City/State Zip Phone
-7 i,i &Ygas JSoi aoo -ForseeJuras , co 30:0,;zq 976-61/1- iz 3J.
..Contractor Address :;City/State Zip =Phone
(2EgT�2 F.n-C.JJ!72a i(rf t�vr,ri,�� i,Soi 444av:&y cr4 oc..n�z, eezzws ca. -wl�f t7.7d=7`t7-27Gv
_ Contractor.City'of:Ft: Collins:Sales7ak-4 Areyoq-paying:taxes here or by.report?-D'Here ❑:.Report
._Saies&?xnumberisrequiredbyaiicon&acmrs ;Are:you-payingwith:your trust accountKOYes --0M
_Is this a residentiat or -commercial project? ';.Residential ❑ _Commercial
Ifsesidential; is. it: -J Sipgle Family Detached - ❑ Condo/townhome (sing le.farhfly.attached) ❑ Duplex
'-.❑ Multifamily_(apartmerit) ._❑':Garage
If. commercial, is:it _❑.Bank'::❑ Bar ❑ Church ❑.Hotel/.Motel_.❑'Medical office `❑ office :.❑ Retail
❑:Restaurant -' ❑:Other (explaih),
-As this building 50 years of.age or more? -0 Yes.❑.No I£yes,.youmayneed to. contact-HistoricPreservaiion
Ifthis is for a.demolition permit, what year:was the:building.constructed7.
.:.Description of .work 44- oFr e,0mP1.Erc- 2-00tr:'Io ivvog, iwsrAtz
- SyN `>f'l1 E•rtc rFLr� &10 Jew—AN6 W4rcrz 'sarred 4;v6 A ' Y6y,2 '0WIF*vs eogivi.v
'*If..lawn sprinkler/backflow•preventer,,must,listlicensed plumber:-If.first=time A/Ci-must list lieensed;eleetrician.
Subcontractors:.List~the.companyname or City. of Ft Collinslicense,#
Electrician Plumber :. Mechanical Roofer. Z U'Ue Z- '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 cityordinances and state -laws regulating building construction. I know that a
.permit is not valid uritil.it has been paid and issued.
Applicant:
Print Name: rl"" i3'4'/ "'� signature. f�6`i'�"� "Date 9"ai"ib
IN
Revisiondate 2162017