HomeMy WebLinkAbout155 Boardwalk Dr - Applications/Demolition - 03/21/2012Planning, Development & Transportation
City Of 281 N. College Ave P.O. Box 580
FortCollins Fort Collins, CO 80524
Phone 970-41616-2740740 Fax 224-6134 .
OVER-THE-COUNTER PERMITS ONLY
Thi application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
N 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 # I ; (J
For office use only
Date T) / -.)—
Job Site Address (required)
Value of Construction (labor, materials, profit)
/ss 0AR w j4l 2>I?. FL-1
FTC, c o 5000
Property Owner Name Address
City/State Zip Phone
t4N B a,k) 656C 14T-E'S Lt- C_
64mo FTC C o OS>S 7
Applicant Name Address
City/State Zip Phone
TN C—
Con'ttractor Address
City/State Zip Phone g%o-W
IrlIc NCetJAA) Co. LLL-Y o2lFo7o
11
C,Ae65PtcT PJi FTC e o '4�o$'s1S
Contractor City of Ft. Collins Sales Tax #
Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax num erisrequiredbya//contraoors.
Are you paying with your trust account? ❑ Yes /(No
Is this a residential or commercial project? ❑ Residential .Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: 2T Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ArNo Ifyes, you mayneed to contac Historic Preservation
If this is for a demolition permit, what year was the building constructed? /9S 3
If prior to 1975, you will need an asbestos assessment to submit with this application:
on of work .bCM6L1T1uYJ OF Eyt57
L
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
INNoJh�,� INiypniJhlVFi
Electrician 1 /� �Kylreua'T. Plumber yy ig, Mechanical y►-;,MO(At. 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 E
Print Name:>t-12tti Signature
Date A 1 ! )'_
► 4_117