HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 11/3/2014 (5)City of
FF6rt Collins
Planning, Development & Transportation
281 N. College Ave P.O. Box 580
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 ARoofing ❑ 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 # D_ (2 Date ff 3 W
For o ice use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name Address
City/State Zip Phone
37 r,
2 q 5—z/ o l
Applicant Na"��"�� Address
City/State Zip Phone
�� �v /
�oZCv �1'70 011-S773
Contractor Address
City/State Zip Phone
00 Z52- 974-01F- ?773
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? A Here ❑ Report
Sales tax number isrequiredbyall contractors.
Are you paying with your trust account? ❑ Yes ZNo
Is this a residential or commercial project? aResidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
gMultifamily (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 A'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 w[bi 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
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: �J
Date