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HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 11/3/2014City of Planning, Development & Transportation Foy 281 N. College Ave P.O. Box 580 rt 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 information on the application. Incomplete applications will not be accepted. Application # / Date I/- 3-10 For of a use only Job Site Address (required) Value of Construction (labor, materials, profit) 7Z• 75 60 941,/�ir Properly Owner Name G� C Address City/State Zip Phone 61"144 /1 -7 Zg 5 - �-NI) l Applicant Name Address City/State Zip Phone J &&n ©"h 7116 .59 tglhs; A &Q Y65Z1P M-zt -87'7 Contractor Address City/State Zip Phone _ xS 7/1s. �. Vtr elj S7 4 Co 65Z_ a 9 Q ..Zlq_ 8773 Contractor City of R. 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 XNo Is this a residential or commercial project? k15itesidential ❑ Commercial If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex CO -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 CE3-No If yes, you may need to contact Historic Preservation If this is for a demolition permit, what year was the building constructed? Ifpnor to 1975, you will need an asbestos assessment to submit with this application. Of -s92 *If lawn sprinkler/backflow 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: ASAt�t (j1�i:�ZFj Date // .7 %7