HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 11/4/2014 (4)City of
F6rt 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 ❑ 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 # I31 9j 13-1 Date
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Pro erty Owner Name
Address
City/State
Zip Phone
37 a/.-� t.�
�a�
Cid z�1
Applicant Narnpl
Address
City/State
Zip Phone
7/2 S S �.,eelh
57.
�770- Z 19-- P77
Contractor
Address
City/State
Zip Phone
i�, l�reti
I16 , /�Sel S Si
(XZ�P �70 Z!1?-877
Contractor City of Ft. Collins ales
Tax #
Are you paying taxes here or by report? , l Iere ❑ Report
Sales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes kNo
Is this a residential or commercial project? AResidential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
^s 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 4 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 work
*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
Date // `/ —/