HomeMy WebLinkAbout4501 Boardwalk Dr - Applications/Water Heater - 04/29/2016APR/29/2016/FRI 11:29 AM FAX No, P,003/003
Cityof Planning, Development 8t rt
Transpoation
281 N. College Ave P.O, Box 580
%4:% F6rt CoWns 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
i] Demolition (interior non-structural) O Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit )0 Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing t3 Sewer Line ❑ Photo -voltaic
❑ Ventilation 14 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 # 9) (D Date
For office use only
Job Site Address (required) Value of Construction (labor, materials, profit)
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Property Owner Name Address city/State Zip Phone
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Applicant Name Address Clty/State zip Phone
Contractor J Address City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? Rf Here Q Report
Sales tax nurp i q dbya//con&acior$ Are you paying with your trust account? eYes M 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 Q Church ❑ Hotel/Motel a Medical office ❑ Office ❑ Retail
❑ Restaurant 13 Other (explai )
Is this building 50 years of age or more? ❑ Yes WNo If yes, you may need to contact Historic preservat/on
If this is for a demolition permit, what year was the building constructed?
Ifpr/or to 1975, you will need an asbestos assessment to submit with this application.
Description of work
*If lawn sprinkler/backnow i4eventer, must fist licensed plumber. If first-time A/C, must: list licensed electrician.
Subcontractors: List the company name or City of Pt Collins /lcense 0
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 regufating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: d�
Print Name; d 1 t.) Signature pate