HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 11/4/2014 (3)Planning, Development & Transportation
City of 281 N. College Ave P.O. Box 580
F6rt Collins 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 ❑ 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 # PI `'( ( 1 3EXy Date
For ofce use only
Sob Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Phone
1400 1 L
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Applicant N e
Address
City/State Zip Phone
Q19-74 7//3' S. 5—i.4'/A 51 A0 AQ BoSZLo 97D-z/9-er;` j
Contractor
Address
City/State Zip Phone
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15 s b
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Contractor City of Ft. Collins Sales Tax #
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Are you paying taxes here or by report? MHere ❑ Report
Sales tax number is required by allmntractors
Are you paying with your trust account? ❑ Yes RNo
Is this a residential or commercial project? g Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Cando/townhome (single family attached) ❑ Duplex
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 ;(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.
*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
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