HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 12/8/2014 (3)City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Flirt 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 XRoofing ❑ 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 # 1� f ( D-5(a 5 Date 1- F-/ta
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit
S�e cr i�Gf/
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Property Owner Name
Address
City/State Zip Phone
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�-�- �- 71
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Applicant Name
Address
City/State Zip Phone
7 /
. 5
57- O o6b52-1 87 72
Contractor
Address
City/ tate Zip Phone
1 lia1tW)14,o,'
6. T.
Mfle-ldrJ .. L' vd MZLv 770-7/9- F773
Contractor City of Ft. Colli s Sales Tax #
Are you paying taxes here or by report? Omere ❑ Report
sales tax number is required by allcon"ctom
Are you paying with your trust account? ❑ Yes , o
Is this a residential or commercial project? Pg Residential ❑ Commercial
If residential, is it: ❑ Single Family Detac ed ❑ Condo/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 gNo 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.
Description 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 Name:JASsy?— Signatu Date
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