HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 11/3/2014 (4)City Of Planning, Development & Transportation
Fy} 281 N. College Ave P.O. Box 580 �v
ort CORMS Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134 c
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 # R / W / Date //- ?— A/
For o>iice use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
4_9D0 _j'AL
74-75-50
Property Owner Name Address
City/State iip Phone
Applicant Name Address
City/State Zip Phone
4 7115
-4 Ca &YLLy F76 - Z/ -
Contractor Address
City/State Zip Phone
-4. - _
<34.�e AV& 910-ZIf-,?77
.
Contractor City of Ft. Collins ales Tax #
Are you paying taxes here or by report?/,�liere ❑ Report
Sales tax number is required by all contractors
Are you paying with your trust account? ❑ Yes RNo
Is this a residential or commercial project? �Mesidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
CZ -Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50,—,Nars of age or more? ❑ Yes - FkNo If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifjonor 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. __ Signature._� ZI Date A=����