HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 2/19/2019Planning, Development, & Transportation Services
Fort C®Wns Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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 1AWater 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 # I- I 0 I ASS Date 2
For or ice use only
Sob Site Address (required) 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
V[ ,s S*. F 0052L1 L 1b
Contractor City of Ft. Co ins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contractors Are you paying with your trust account? >(Yes ❑ No
I. M-79l
Is this a residential or commercial project? L(Residential ❑ Commercial
If residential, is it: ❑ ingle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (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 ❑ No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work
'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: J (y((A .9I-Li a Signature Date
Revision dale 2M2017