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HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 12/8/2014 (5)City Of Fort 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 O 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 # T/l L� I For orrice use only Date /;?-� Job Site Address (required) Value of Construction (labor, materials, profit) y9oa it' /c a. AC Goa AI 7- 751 sQ Property Owner Name Address City/State Zip Phone A/6 I.% I L WL51. tZon sfr A Applicant Name Address City/State Zip Phone J ` -7 SA/'ea C. ev U-u -F*773 Contractor Address City/State Zip Phone 4a1l/n.s ALLej &C, 71/3- 7057LP 97d-Zlej• 8773 Contractor City of Ft. Collins Sales Tax # Are you paying taxes here or by report? ,Here ❑ Report Sales tax number is required by all contractors Are you paying with your trust account? ❑ Yes _No Is this a residential or commercial project? Residential ❑ Commercial If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex /ig-Multifamily (apartment) ❑ Garage. If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building SO years of age or more? ❑ Yes JB: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. Z• *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 12-4-�