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HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 6/4/2019r itv of Planning, Development, & TPanspodation Services .11F0et CoWns Community Development c Neighborhood Services �4 281 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). 0 Air Conditioning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilation Water Heater ❑ Water Line ElWood/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 # r-:,.� ( q6 4 17 (0 Date For office use only Job Site Address (required) Value of Construction (labor, materials, profit) q0too N-2ca25 0,0- Property Owner Name Address Crty/State Zip Phone i . F c, 2 R40' 223 - Applicant Name Address City/State Zip Phone Nan IM16no, 30 . F k CAIns 'SOS LI tA •! &A Contractor Address City/State Zip Phone ?kUffivim, SOCA tAvIvs, y� Contractor City of Ft. toollins Sales Tax # MQ. k15 Are you paying taxes here or by report? ❑ Here ❑ Report Safes taxnumberls utredbyaiiconrractom Are you paying with your trust account? Yes ❑ No l O 27 Is this a residential or commercial project? NAesidential ❑ Commercial If residential, is it ❑angle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex ultifamily (apartment) ❑ Garage If commercial, is it: Bank ❑ Bar ❑ Church © Hotel/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 50 gears of age or more? ❑ Yes ❑ No If yes, you may need to conmctHlstorlcPreservatton If this Is for a demolition permit, what year was the building constructed? Description of work 0. p *If lawn-sprinkler/backiiow preventer, must list Ifcensed_plumber. If first-time A/C, must list licensed electiridan. Subcontractors: List the campanynameorGtyofFtCoiiinslicense 9 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 ail 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: // 1 Print Name: Signature alill'y EkC4-Date- datD2WD17Fauf[Sian