HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 4/16/2018 (2)Apr 02 2018 05 46PM HP Fax page 2 VIV9,1 �
C ty c+ Planning, Development, & Transportation Services
Fbin Collins 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) ,KAir Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
KHeating 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
Applicabon #_ 1IV03144 — & I U f� Date 4 %6
Foroffix use only 61 V 03 v— "{ lJL�
Job Site Address (required) Value of Construction (labor, materials profit)
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Property Owner Name Address City/State Zip Phone
Applicant Name Y Address City/State Zip Phone
Contractor Address City/State Zip Phone
Contractor City of R Collins Sales Tax # Are you paying taxes here or by report? O4Here ❑ Report
Sales tax n ember is ra°qu/red b allcnntradvis Are you paying with your trust account? ❑ Yes -f 10
Is this a residential or commercial project? XResidenbal ❑ Commercial
If residential Is it ❑ Single 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 yeam of age or more? ❑ YeSA!f. o Ifyes yvu miay need to Conran HWOM PreSer"o+on
If this is for a demolition permit what year was the building constructed?
Descriptgri of work Agoflobt
/ 2!� N h& r
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*If lawn sprinkler/backflow preventer must list licensed plumber If first-bme A/C, must list licensed electrician
Subcontractors List the company name or city of R Collins license #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete-LARd correct I agree to
comply with all requirements contained herein and city ordinances and stabe laws regulating bu struction I know that a
permit is not valid until it has been paid and issued ✓-"
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Applicant ¢�-S
Print Name ignatu to
Rea andais 2&20V