HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 12/10/2014 (4)City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
F6r + l 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 612RCRocifing ❑ 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 #_ eD(,4 I ,2,LO52- Date /D-.
For office use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
Woo 46. 40"djaVG J-,
&1 a Pe- 9 7 53---ZLf 561
Property Owner Name Address
City/State Zip Phone
7 h o SF hA_, Zoys -M- 10)
A plicant Name Address
City/State Zip Phone
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,- C'a Z(o y o-21?-7773
Contractor Address
Q'C_'
City/State Zip Phone
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70- 8
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 .gfNo
Is this a residential or commercial project? OResidentiai ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ 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 D51010 If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
If pnor 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: a
Date