HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 4/22/2013Planning, Development& Transportation
City of 281 N. College Ave P.O. Box -%0
Fort Cq- -s Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
:.OVER-THE-COUNTER PERMITS ONLY
This application Islo be used to apply for the following permits only (check all that apply) ' 0 Air Conditioning
"-
0 Demolition (interiornbri-structural) 0 Electrical Alteration (not service change) 0 Gas Lightsf 0 Gas Log
0 Heating Unit 0—Lawn Sprinkler 0 Mobile Home replacemenit 0 Roofing 0 Sewer Line 0 Photo -voltaic
OVentilation DWater Heater OWaterLine 0 Wood/PelletStove (must be EPA certified, provide make, model and
manufacturer).
Complete.all applicable Information on the application. Incomplete applications will not be accepted. 00
ApplicationDate
For office use only
lob Site Address (requIred)
Value of Construction (labor, materials, profit)
&T 'DO
MA14144,t
Property Owner Name' Address
City/State Zip Phone
C//
Applicant Name Address
City/State Zip Phone
Corib-actor Address
City/State Zip Phone
-4 9 z2z,24
JEM7 A>t4l� f
Conbwtor City of R. Collins Sales Tax #
Are you paying taxes here or by report? 0 Here 21:1keport
sales tax number Is requifed by all contraaom
Are you paying with your trust account? 13 Yes 0 No
esidential — 1 mmercial
Is this a residential or comrnerCtaLprojeCt? )YR tt�n
If residential, is it:'-'. 0 1 0
-Single Family Detached 0 Condq/tp me (single family attached) 13 Duplex
ti13family (apartment) ❑Garage
M � If commercial, Is it'P0nk C3 Bar [3 church 13 Hotel/M6tel". 0 Medical office El Office 13 Retail
13 Restaurant EI Other (explain)
Is this building 50,years of age or more?
? OYes pft If yes, )vil may need to contact Historic Preservation
If this Is for a demolition permit, what year was the building constructed?
If
pnor to 1975
,
you W1 need an asbesfoS assessment to sUbmit r Wffi ffijS application.
Description of work
114L
*If lawn sprinlder/ba_ckflow preventer, must list licensed plumber. Iffirst-time A/c, must list licensed electrician.
SubcontractorsL6tthe company name or Cty of ft Collins license
Electrician Plurntier Mechanical Roofer Other
I hereby acknowiedgethait 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:
Print Name: Signature Date -22 62