HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 7/8/2019 (2)City of Planning, Development, & Transportation Services
16rt CoRins Community Development & Neighborhood Services
Vt 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 ❑ 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 # 16 J �%g Date ,• g' %CJ
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
clm ar C fir. U, - Z 0=
Property Owner Name Address City/State Zip Phone
MtrUmon r 1.22 .y
Applicant Name Address .. City/State Zip Phone
Fo '806Ll Lk •'1 to62)
Contractor Address City/State Zip Phone
4i t 46
Contractor City of Ft. lebillins Sales Tax # K?. 15 Are you paying taxes here or by report? ❑ Here ❑ Report
Sales Wnumberisre wired by all conbaclors Are you paying with your trust account? 3(Yes ❑ No
IAZ!
Is this a residential or commercial project? Residential ❑ Commercial
If residential, is It: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
1XMultifamily (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 If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of wwo[k
*If lawn.(spprinkler/bacllkflow preventer, must list licensed piumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the companynamg or City of Ft coll/nslicense
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:MILICASignature _ Date•
RmiSion dale 2 2077