HomeMy WebLinkAbout5220 Boardwalk Dr - Applications/Air Conditioner - 06/12/2018p 7-�
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Planning, Development & Transportation
281 N College Ave P O Box 580
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 applicabWIrmation on t 711cadon Incomplete applications will not be accepted
Appticabon #
Fo o"ae use only
lob Site Address (required)
- Value of Constructs bor, mate is, profit)
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Property Owner Name Address
City/State I lipPhone
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Applicant Name Address
Gty/State Zip Phone
Contractor Address
City/State Zip Phone
Contractor City of It Collins Sales Tax #
Are you paying taxes here or by report? ,d Here ❑ Report
Sales tpx number Asrequrredbyall contactors:
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Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial prolect7 EIResidential ❑ Commercial
If residential, is it ❑ Single Family Detached Condo/townhome (single family attached) ❑ Duplex
❑ Mulbfamily (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 morel ❑ Yes ❑ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building ooi
If pnor to 1975, you iw// need an asbestos azewwt to submit r
Description of work
this application
*If lawn sprinkler/baddiow preventer, must list licensed plumber/If first-time AtC, must list licensed electnoan
Subcontractors List the company name or City of Ft Colons li se #
Electnm 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 lawn regulating budding construction I know that a
permit is not valid until it has been paid and issued
Applicant
Print Name I . Signature Date z