HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 11/3/2014 (2)Planning, Development & Transportation
City of 81 N. College Ave P.O. Box 580
F61 t Collinsol 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 El 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 # :'o ( qI I
For office use only
Date 4 I—E ` (
4
Job Site Address (required)
Value of Construction (labor, materials, profit)
ALj/' /L 1
u
S� 75- 561
Property Owner Name
Address
City/State Zip
Phone
C ZZ 6fra-Am2�i
leSo8-�io/
Applicant Name
Address
City/State Zip
Phone
rr
i - cI
57. -i:6 & 9052
`17o- Z/9-F77.7
Contractor
Address
City/State Zip
Phone
J
fry
5 re/ S 5T 9OZtp
970-�t- ! r77>
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
)aAere ❑. 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? ji.Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
dg-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 19-No 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.
of
*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-1 Ln
Date //-3-/Cf