HomeMy WebLinkAbout4900 DAKOTA DR - APPLICATIONS - 10/23/2018clay o� Planning, Development, & Transportation Services
,-Fort Collins Community Development & Neighborhood Services
�- 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 # 1910 � Co 0 3 Date /o- z 3- 1
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
y406 i_).41eorA 69 F„:r C'ou.)•, s in r16Sz e Zo 4 L sru;ay
Property Owner Name Address City/State Zip Phone
EL7z�gr-rti l3E2�4v sT c19oo DµK,s;a an i.,.zr eOLct..,; en yvJ"Zg 6,19- 717- 65/G,
Applicant Name Address City/State Zip Phone
TM 13.oyg..S i5e5i 7!ln�t=n+y C7' .p"too i oa r ec:-L,,_ j eo kui 2�l 4 7u -! 'i! -12 36
Contractor Address City/State Zip Phone
G28nTr2 F/4;..er / a�r.E 2o,r. 7 /S"o. i+can mq r.T /kya r=aa7 Ccui,^5 cc 5uS lc/ Y71.1'-797• 274o
Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number isrequired byaii.mno-actors. Are you paying with your trust account? ❑ Yes ❑ "No
Is this a residential or com ercial project? Residential El Commercial
If residential, is it: Ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church .❑ Hotel/Motel ❑ Medical office ❑.Office ❑ Retail
❑ Restaurant ❑ Other (explain)
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?
Description of work rat. cnr! A1FCie1-';1, i.• >pt r Ma_ t.ruu6 2c; , i-vyr
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*If lawn sprinkler/backtlow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List tlrecompany name orCity ofFtCollins license# J
Electrician Plumber Mechanical Roofer L 4'"'4 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 city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and Issued.
Applicant: c �
Print Name: /!!� i zc .t S Signature w — Date
Revision date M12017