HomeMy WebLinkAbout5220 Boardwalk Dr - Applications/Reroof - 05/26/2015 (5)of
Manning, Dewelopmeat & Transportation
F6281 N. kve r �+ottin3� 0Y- I Fort Collins! Oege p80524 .C. Flax 58a
�.• Phone 970-4i&r.274o Fax 224-6134
OVER-THE-COUNTER PERmas ONLY
This application is to be used to apply for the following permits only (check all that apply), O Air Conditioning
ID Demolition (interior non-structu* Ei Qewcal Alteration (not servi change) 0 Gas Lighter 0 Gas Log
❑ Heating Unlit ❑ Lawn Wrilder El Mobile Home replacement loofiing ❑ Sewer Line C3 Photo-vohaic
❑ Ventilation ❑ Water Heater 0 Water Line 0 Wood/Pellet Stove (must be EP'A certified, provide make, model and
manufacturer). ,
Complete all applicable information an the application. Incomplete applicatlions will not be accepted.
Application # 'Date fL^� 20/6
For affAw use only
Sob Site Address !require)
Property Owner Name
Name
Value of Constbruabon (labor, materials, profit)
i $ 50-S�-
Address City/state Zip Phone
Address
qPrdTactXjYL/ l3c # Address
! . rtXrn-r ink , ��35
Conti -actor City of FLJCollins Sales Tax #
Sakstaxnwnberisregr&Wbyellcon acmrs
aty/State Zip Phone
-70153
city/state Zip Phone
Are you paying taxes he re or by report? Here 0 Report
Are you paying with youir trust account? Yes ❑ No
Is this a residential or commercial pmjimt? dential ❑ Commercial
1f residential, is it 13 Single Family Detached >t�jondoftwnhome (single family attached) ❑ Duplex
❑ Muhifamily (apattrttent) ❑ Garage
If wrnmerciai, Is it ❑ Bank ❑liar ❑ Church O iiotel/Moiler i] Medical omce ❑ Office 17 Retail
i7 Restaurant El Other ( n)
I5 this bolding 50 years of age or more? E7 Yes XMO lfyes, you meyneed m awtAt Hz&1Yc Prese mbvn
If this is for a demolition permit, what year was the building constructed?
Ifprlor to 1975, you will need an asbestos aZesvnenttn subm/t wits, tb/sappllydtbon.
Desaiption of work
*If lawn sprinkler/baWow preventer, must list licensed plumber. If fM-time A/C, must Ilist licensed electrician.
SUM01 acbois: W tfa company name or ay ofM colfns licaasm #
EkthiGian Plumber Mechanical•—_ Rooftir Other
I hereby acknowledge that 1 have read this applicalign and state that the above Information is complete and correct. I agree to
comply WM all re"iniments containedherein and c1tv orfinanoes arid state laws reguMn!g buildna conshueBon. 11mow that: a
Pernik is not valid unlit has been paled and issued.
l�rrttt Narma: tJ4. .�c,(Ae-y- _ Signature - y- t3 u��— Deft