HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 12/8/2014 (4)City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
! „ort 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
,Iinformation
�on the application.
Application # t J as `��
or office use only
Incomplete applications will not be accepted.
Date /Z'$ ` A/
Job Site Address (required)
Value of Construction (labor, materials, profit
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30n / s-y
Property Owner Name
Address
City/State Zip
Phone
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Applicant Name
Address
City/State Zip
Phone
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9749-7,1-777
Contractor
Address
City/State Zip
Phone
!s. 5.
'Vislas ST- k1176 705-ZIo
97o - Z /e1- JV7
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
J3?-Here ❑ Report
Sales tax number is required by allconbactors
Are you paying with your trust account?
❑ Yes ANo
Is this a residential
If residential, is it:
If commercial, is it:
or commercial project? Rg-Residential ❑ Commercial
❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
)S-Multifamily (apartment) ❑ Garage
❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes OcNo tf 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
*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: XWI
Print Name: >✓s'�J`C pv!e4�'V14 a
Date XZ`"d-7�_