HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 11/2/2015 (4)City of Planning, Development & Transportation
B o 281 N. College Ave P.O. Box 580
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�t Coifi s 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 information on the application. Incomplete applications will not be accepted.
Application # 7?=>1 S 01 E Date
For office use only
Job Site Address (required)
V240 E, 2a 0W c D4
A122f'
Value of Construction (labor, materials, profit)
d 62S vo
Property Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
City/State Zip
Phone
Contractor
Address
City/State Zip
Phone
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report?
❑ Here ,O"'Report
Sales lax number is required by all contactors
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? f YResidendal ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached)
P�ultifamily (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 O'No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Ifprior to 1975, you will need an asbestos assessment to submit with this application.
of work
❑ Duplex
*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: �/� ,1
Print Name: i%fl#lwlz'l /"/`-/�l /L/>ZSignature Date