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HomeMy WebLinkAbout4501 Boardwalk Dr - Applications/Reroof - 07/06/2015Clt Of Planning, Development & Transportation Fper. 281 N. College Ave P.O. Box 580 ®1 6 Collins1Fort Collins, CO 80524 Z Z S 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 # fb 1 Sn S 1 c-t 1 Date J'7 �116 For office use only Job Site Address (required) Value of Construction (labor, materials, profit) ,f -col _�oa..rdvuad k l fd 44 1146 ? Property Owner Name Address City/State �d010d vlsbrl- /ijr -FaACFK N09 I'_e&VmU[0yA Mtutha-Iktnr Zip Phone KS 6&5©2 Applicant Name Address City/State Zip Phone ATC F, Cr/8 UJltnshu , Co 60530 97o 663-3ydo Contractor Address City/State Zip Phone -TC 034A 61 C09 4,)Ju/1ZJnv►U M 053,` � 97661,33ft 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 ❑ No Is this a residential or commercial project? ❑ 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 ❑ No If yes, you mayneed 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 L—f DOf 38Su. 3Q!J,,3 llvtnlTS *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 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: j Print Name: Signature �Dgi� VI C g Date 7