HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 12/9/2014City,Of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
ForCollins 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 0 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 # T:>1412S$$ Date / 2-9�k-IV
For ofTrce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Property Owner Name
Address
City/State 2�1f y Zip Phone
Applicant Name
Address
City/State Zip Phone
4.
d -u-
Contractor
Address
City/State Zip Phone
Lctry_-w. LIZ
-7 5% 5-Shiw�&
2 -�doh 9292-0 97Q--?'19-,F'7_7?
Contractor City of Ft. Collins kales Tax #
Are you paying taxes here or by report? Mere ❑ Report
sales tax number is required by allcontractois
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
M-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 4ONo If yes, you may need to contact HistoncPresemanon
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, you MY need an asbestos assessment to submit with this application.
of
*If lawn sprinkler/backnow 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: 'iy7 ([�f� Signa. Date