HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 11/4/2014 (2)City of
F„6rt 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 �LRoofing ❑ 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 # �`� I I �g � Date INI-1V
For office use only
lob Site Address (required)
Value of Construction (labor, materials, profit)
zl,?a0 law.,olL-l/a//! Pl-
0
05-
7 s s :
,XXLe
_ .
Property Owner Name 3
Address
City/State
Zip
Phone
Applicant Nang
Address
City/State
Zip
Phone
/ �/
us S /.�f V
!:�p
91 d-zi9 e77777
Contractor
Address
City/State`
Zip
Phone
�d,L
115" 1,
AlleM
A, Z&
�17D•-7,l - .�1777
Contractor City of Ft. Colli s Sales Tax #
Are you paying taxes here or by report?
-Here ❑ Report
Sales tax number is required by allcontraclors
Are you paying with your trust account?
❑ Yes ANo
Is this a residential or commercial project? IXResidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
t"ultifamily (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 12r-No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
of work
Z.
*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: J
Print Name: Signat ��Date Y