HomeMy WebLinkAbout4501 Boardwalk Dr - Applications/Water Heater - 09/30/2014City O$ Planning, Development & Transportation
®pt LLin For N. College Ave P.O. Box 580
"a.-'.— 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 # 6 ( L� 0 L na' Date
For office use only
01. 30 -14
lob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
a�D?b(0'Ac)1U
Address
S 63W comffC
City/State Zip
r—Koll Inzosl-a
Phone
9-�OzI-1 1?
Applicant N me
Address
City/State Zip
Phone
Contractor a�n -
e i
Address
�.1� L.
City/State Zip
Co in $OS�
Phone
�l0 ad 1 CY
V1 C lef
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ❑ Here Report
Sales tax number is required by all contractors. Are you paying with your trust account? ❑ Yes hNo
Is this a residential or commercial project? A Residential ❑ Commercial
If residential, is it: ❑ Single 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 ;!!�lVo Ifyes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If prior to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber I 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: B/ n
Print Name: 1 C,j �l UUU���JJJ (, "►(I I,l Signature67:=Date
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