HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 12/8/2014 (2)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 # Date
For o>tice use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
G
&C Cd
osZs` J G, Z. 75-
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Property Owner Name
Address
City/State Zip
Phone
C
50 CA
A plicant Na a
Address
City/State Zip
Phone
�►-� ll .
q70-114-877
Contractor-
Address
City/State Zip
Phone
i�ld% W115,
5-
- QiDSZC
970--Z/ f -877
Contractor City of Ft. CollA Sales Tax
#
Are you paying taxes here or by report?
JXHere ❑ Report
sales tax number is required by all contractors
Are you paying with your trust account?
❑ Yes ATO
Is this a residential or commercial project? %Residential ❑ Commercial
If residential, is it: ❑ Single Family Detach6d ❑ Condo/townhome (single family attached) ❑ Duplex
�4ultifamily (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 43�.Ple- Ifyes, youmayneed 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
*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: Signa Date /Z' 7