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HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 7/8/2019aty Of p Planning, Development, & Transpartadon Services `Fdrt dins Community Development & Neighborhood Services E3 281 North College Avenue Fort Collins, CO 80524 Main: 970AI6.2740 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 Cl 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 1$( 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. Application * (h10-)AA0b Date 1 $ Iq For office use only Sob Site Address (required) value of Construction (labor, abar! Is, profit) 490 _12500 Property Owner Name Address City/State Zip Phone M �IqO c. T168652.8 910 •ZZ3-9940 Applicant Name Address City/State Zip Phone 16A cAne,S052A I.1 A .1(06% Contractor Address City/State Zip Phone 1 1.16 Contractor City of Ft oilkns Sales Tax# MQ-1's Are you paying taxes here or by report? ❑ Here [3 Report Sales taxnumber is ulred by all contractors Are you paying with your trust account? %Yes I] No t0'MA Is this a residential or commercial project? Residential 0 Commercial If residential, is it: _ C? Single Family Detached 17 Condo/townhome (single family attached) ❑ Duplex /�`7 Multifamily (apartment) ❑ Garage If commercial, Is it: ❑ Bank ❑ Bar ❑ Church ©,4otef/Motel ❑ Medical office ❑ Office ❑ Retail ❑ Restaurant ❑ Other (explain) Is this building 5o years of age or more? ❑ Yes ❑ No if yes, you may need ro confactH/stor/c PreservaVon If this Is for a demolition permit, what year was the building constructed? Description of work — *If lawn: sprinkler/bacJdtow preventer, must list licensed plumber. If first-time A/C,. must list licensed electrician. Subcontractors: Listdre companyname or aty of FtColllnsllcense 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: c, Print Name: 5ignaWre ate. ReMan Gate?R w