HomeMy WebLinkAbout4745 Boardwalk Dr - Applications - 03/24/2004 (3)City of Fort Collins
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
BUILDING PERMIT APPLICATION
Last ,� (( First
�4✓K
Middle
Phon,6
d
��'� ira mont- VY"�"ICe C-
3
0
Street Address Please Specify., LN. DR. CR. WY. PL. ST CT. RD. AVE.
City State
Zip Code
Company Name License Number
Supervisor & Cert. #
Co TJ - 4—
r , c n5%ruck'()V)
t5
Mailing Address City
State
Zip Code
cc
P,D.-BO}L X1270 rt 00/ ir1S
C'_b
gbSa
Please Specify: LN. DR. CR. WY. PL. ST CT. RD. AVE. Zip Code
JOB SITE ADDRESS � M
Ale
Subdivision/PUD
o, fA it Y a- ry) 6 yk
Filing Number Lot Block Lot Area
Building Square Footage Number of Stories Building Height
o
L (Q X ,
Number of Bedrooms/Bathrooms Finished Basement Square Footage
0
1
Value of Construction (including labor, material, profit) $
Description of Work: 54-
(� r
Subcontractors:
Electrical 1+ a 'ff
Roofing
R
w
.Q
c.
a
Mechanical -Po uclre Uo (fey &K Plumbing � � 11,frJ.
Concrete Framer
I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all
requirements contai d herein and ci ordinances and state laws regulating building construction.
Signature
Print Name_ IJorri e� yss Phone VP- -2 �� — ZZ
Distribution: Original — L & P Yellow — Office
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE