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HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 7/21/2017A ?gut Collins OVER-THE-COUNTER PERMITS ONLY This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning © Demolition (interior non-structural) Q Electrical Alteration (not service change) 0 Gas Lighter Q Gas Log .• 0 Heating Unit i3 Lawn Sprinkler 0 Mobile Home repiacsment ❑ Roofing 0 Sewer Line -13 Photo-voitaic 0 VenUiateor ifaier Heater 0 Water Line 0 Wood/Pellet Stove (must be EPA cartifted, provide make. model.and manufacturer). Complete all applicable Infornlatiorilon the application. Incomplete applications will not be accepted. Application #✓�I Li-,i�Afo Date —�m ForaRxe use ordy cob Ske Address CXW#1 Planning, Development &TransportatiOn 281 N. College Ave. - P.O. Box 58D Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 Value of Construction (labor, materials, profit) - Address I355 �Y/51�te Vey Zip Phon l o Applicant Name ! Address COY/State Ztp a! Phone ��j�fL'il �,�i G-•.l`.+�., r.! -I=a� r'��S d�i:�^ _ r �+r ��U ^���?�1 L Contractor Lic # Address City/State Zip Phone >^ s rr�+rt S��R S:�itrri S13�7� Contractor City of FL Collins Sales Tax # �Y cv�- Are you paying taxes here or by report? 0 here XReW Sales tax nrenbprlsrequirad byaBNnbeuYvrx Are you paying with your trust account? gYes ❑ No Fs this a residential or commercial project? OResidentlal ❑ Commercial _ If residential, is it: .Single Family Ootached O Condo/townhome (single family aMched) ❑ Duplex 12 Multifamily (apartment) 0 Garage If mmmercial, is It:0 Bank ❑ Bar El Church ❑ HoteUMobW 0 Medical ofHee D Ofrit e ❑ R ail ❑ Restaurant 0 Other (explain) is this building So years of age or more? Dyes D No byes, you mayneed W cnnZxtH aYC PraRb3raVOn If this is for a demolidan permit what year was the building constructed? Ifpffor to 1973, kw will need an asbestos assessment to submit WIM &Is 3AO&w6M *If lawn sprtniderlbacknow prevwter, must fist licensed plumber. If first-time A/C, must list licensed efectridan. Subcontractors4 [ISl the[ampanynameorGtyofRCu/Ivs6censa = i - 6ecbidan Plumb us medranical Roofer Other I hereby admowledge dots have read this appilumtkon and state that the above Wormauion is complete and tarred_ I agree to comply with an requirements contained heron and city ordinances and state laws regulating building consbwdon. I know that a permit Is not valid until it has bam paid and Issued. Applicant: _i .... __ Print Name, 4-174-w f G C sign / -- �' Dante Z 9-d 9L70-Z8b-OL6 Auodwoo eowes uuewile d8Z:90'L L LZ Inr