HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 12/10/2014 (6)City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
FOr 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 hoofing ❑ 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 # 6 ( —flI aVS I Date
For ofce use only
Job Site Address (required)
Value of Construction (labor, materials, profit)
8
-/00 35-. zy SR
Property Owner Name
Address
City/State Zip Phone
on / /L e
5;;F 0A
Applicant N me
Address
City/State Zip Phone
Contractor
Address
City/State Zip, Phone
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Contractor City of Ft. dollins Sales Tax #
Are you paying taxes here or by report? fig::Here ❑ Report
5ales tax number is required by all contractors.
Are you paying with your trust account? ❑ Yes �RNo
Is this a residential or commercial project? 1d..Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) 43-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 4a-Plo 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 w/ll need an asbestos assessment to submit with this application.
Description 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:
Print Name: I Signature Date