HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 11/3/2014 (3)Planning, Development & Transportation
City bf 281 N. College Ave P.O. Box 580
1.
FO� Collins�1Fort 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 oofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation [I Water Heater ❑ Water Line ❑ Wood/Pellet Stoeemust be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
Application # R I `7 / I ;�-t Date
For Rriuse only
Job Site Address (required)
Value of Construction (labor, materials, profit)
'WOO
S" .SO
Property Owner Name
Address
City/State Zip
Phone
1111"MA
'97.
�. r xi 2 f
OV-9110-?/41
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
71/5• S• Sh,,eflt
sr A 12J D u
97-0-01 p- J17777
Contractor City of FA Collins Sales Tax #
Are you paying taxes here or by report?
tTHere ❑ Report
sales tax number isrequired byall contractors.
Are you paying with your trust account?
❑ Yes j@7No
Is this a residential or commercial project? A Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
JZMultifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ,ENO If yes, you may need to contact Historic Preservation
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.
❑ Medical office ❑ Office ❑ Retail
*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 Nam
Date zzf-1