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HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 8/20/2014 (2)Fort Collins Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 O Phone 970-416-2740 Fax 224-6134 /Y OVER-THE-COUNTER PERMITS ONLY 9igl 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. 5 Application # k I Yd 65 o_ = For ice use only Incomplete applications will not be accepted. Date �© //pt Job Site Address (required) ^AU�11,49 Value of Construction (labor, materials, profit) 11PPO1-6 41c, /Zr7 - D All Property Owner Name ess City/State Zip Phone km C-�3� Applicant Name Address City/State Zip Phone Contractor Address City/State Zip Phone 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 XNo If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? If pnor to 1975, you will need an asbestos assessment to submit with this application. Description of work L __ !t4Y QtO rati„tJalTi`b *If lawn sprinkler/backfiow 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: Print Name: /L/Wr A/r/Lr�� Signature Date r=zv —/�_