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HomeMy WebLinkAbout5220 Boardwalk Dr - Applications/Water Heater - 04/02/201204/04/2012 06:32 9702329739 PAGE 01/03 Planning, Development &Transporlaltfon 281 N. College Ave P.O. Box %0 Fort Collins, CO 80524 Phone 970-416-2740 Fax 22+6134 QVER-THE-COUNTER. PERMITS ONLY This application Is toibe, used to.apply for the following, permits only (check all that aPPhi)• ❑Air Conditioning 0 Demolition (interior 6orr•81raotural) 0 Electrical Alteration (not service change) I7 Gas Lighter ❑ Gas Log ❑ Heating Unit 0 Lawn Sprinkler El, Mobile Home replacement la Roofing ❑ Sewer Line © Photo -voltaic ❑ Ventilation IKVYata( Heater 0 Water Line O 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 # A Date 2" For rase only Sob Site Address lraiN/rao SZzcD i d Z - Value of Construction (labor, materials, profit) F2- • CO-W RS Go 8D 5a5 lo-i 0 jOa ,V a,)_P - ,. , Property Owner Name: Address City/State (7-C l (,J) Zip 60 S 25 Phone Applicant Name Address city/State 7Jp Phone a t--r 1p0J_M - 405 �b uiwur Ave Love ( Cz &5n vin- 4vi I Contractor Address City/State. Zip Phone U%- exi tam�n 'ram Lti ��5. t�enrprNA I IOWANA Co liw5l Cortbactor City of Ft Sales Tax # Are you paying taxes here or by report? . ❑ Here V Report Collins "fiF &X nuffbwwsrmvku rbyammaftaars • Are you paying With your trust account? lR Yes ❑ No Is this a residential or cdmmendal project? 0 Residential 0 Gbmmerdal If residential, is it: iSingib Family Detached 0 Condo/bownhome (single family attached) 0 Duplex ❑ !IMultifamily (apartment) Q Garage If commercial, Is i� , l7 dank. Q Bar 13 Church la Hotel/Motel 13 Medical office ❑ Office 0 Rail 0 Restaurant ❑ Other (explain) Is this building 50,ysars of.age or more. 3 Yes No IfYm, yvu may rrFerl to cnrime£H/sinNcPVrmerrtt/on If this is for a dernolltiori permit, what year was the building constructed? Ifpriorty1975,you rtiOneadanMbb me/rttosubmitWdhtinsapp/itabon. Description of work *If lawn sprinkler/baddiow, preventer, must list licensed plumber. 'If first-time A/C, must list licensed electrician. SubcontraCEors:.List6)�=MWnYrrarrreorOryoffsCoilinsfraenwde Flech4den Munbar MechanW 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 oonstr cation. I know that a perrnit is not vapid unto, it has been paid and issued. Applicarrtr• . 2 . Print Nae It`YLR.1r Signature babe rz m if