HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 11/2/2015 (9)Planning, Development & Transportation
281 N. College Ave P.O. Box 580
Fort Collins, CO 80524
Phone 970-416-2740 Fax 224-6134
®VEWTHE®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 # SI50-7 S (0 . Date
For office use only
Sob Site Address (required)
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Value of Construction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip Phone
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Applicant Name
Address
City/State Zip Phone
Contractor
Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ,p"'Report
Sales laxnumber isrequired byall contractors.
Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? p Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached)
If commercial, is it:
❑ Duplex
Multifamily (apartment) ❑ Garage
❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes O'No Ifyes, you may need to contact HistioncPreseruat%On
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
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*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
comply with all requirements contained herein and city ordinances and state laws regulating
permit is not valid until it has been paid and issued.
Applicant:
Print Name: /"f. �(M/z/-Signature
is complete and correct. I agree to
building construction. I know that a
Date //`-2