HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 5/10/2018City of Planning, Development, & Transportation Services
ort 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) ❑ 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 0 Water Line ❑ Wood/Pellet Stove (must be EPA certified provide make model and
manufacturer)
Complete all applicable information ojnnttth applicaN�ti1on Incomplete applications will not be accepted
J� c/ V Application # (Vv ��ate
For office use only A)
Sob Site Address (regmred) h__0 Value of Construction (labor, atenais, profit) (U
Property Owner Name Address City/State Zip Phone
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Applicant Name AAA rity/rtatp Zio Phnnp
Contractor Address City/State zip Phone
Contractor City of Ft Collins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
sales axQum all con&actors Are you paying with your trust account? ❑ Yes ❑ No
Is this a residential or commercial project? t10�idenhal ❑ Commercial
If residential, is it ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
C6t a family (apartment) ❑ Garage
If commercial, is it CI Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? O Yes ❑ No If yes, you may need to contact Htstonc Preservation
If this is for a demolition permit, what year was the building constructed
D scriptio of work ; u sf�' yr �o�
*If lawn sprinkler/backfiow preventer, must list licensed plumber If first-time A/C, must list licensed electrician
Subcontractors List the company name or City of Collins license #
Electriaan 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 budding con stru on. I know that a
permit is not valid until it has been paid and issued
Applicant
Print Name C��? Signature ate Q
Revision date 2WO17 "�,�