HomeMy WebLinkAbout4703 BOARDWALK DR - APPLICATIONS - 11/18/2013Cit Of Planning, Development & Transportation
y 281 N. College Ave P.O. Box 580
Forrrt Collins 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 info m�atilon on the application. Incomplete applications will not be accepted.
Application # 5 �"� Date /3
For office, use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State
Zip
Phone
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City/State
Zip
Phone
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Contractor,� pp Lic #
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Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?ere ❑ Report
sales tax number Is required by allcontracors
Are you paying with your trust account.
❑ Yes /i d_No
Is this a residential
If residential, is it:
If commercial, is it:
or commercial project? ❑ Residential Commercial
❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes '0,No If yes, you mayneed to contact Historic Preseruat/on
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
n
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or Gty 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:
Print Name: Sa1(,V_ �Ae c :�gylQ i( Signature
Date