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HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 11/2/2015 (10)City of Fort Collins Planning, Development & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 ®VEWTHE©COULTER PERMITS -ONLII 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 # T5IJ0 7 1U i For office use only Date 1 4. 7W -1 S Job Site Address (required) Value of Construction (labor, materials, profit) VPdD 5-, 9410,6 ev#Z c 24 AP72"' �/ —do Property Owner Name Address City/State Zip Phone 0s D z23 Y 9 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 ,3rReport Saiestaxnumberisrequiredbya//contractors Are you paying with your trust account? ❑ Yes ❑ No Is this a residential or commercial project? 0"Residential ❑ Commercial If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex /Z�iNultifamily (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 p"No 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 will need an asbestos assessment to submit with this application. of work n ..c. �, *If lawn sprinkler/back-flow 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: lti`A' m'er i l hl'z -Signature Date _I ��� `� 5