HomeMy WebLinkAbout4745 Boardwalk Dr - Applications/Air Conditioner - 06/01/2017From 9702299983 1.970.229.9983 Fri Jun 2 12:22:26 2017 MDT Page 4 of 4
FROM FAX NO. Jun. 01 2017 10:03PM P4/4
City rfPlanning, Development & Transportation
281 N. College Ave P.O. lox 580
fort Cott ns Fort Collins, CO 80524
/"--�. Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply), p Air Conditioning
❑ Demolition (Interior non •structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler Ll Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 0 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 #
Fo/ offIrc mS Only
Date 06/01/2017
Job Site Address (r�uur'r/) Value of Construction (labor, materials, profit)
4745 BOARDWALK DR #200 $4,090.00
Property Owner Name
CLARK PROPERTIES
Applicant Name
DRAKE MANOR
Address City/State Zip Phone
514 GRAND AVE #115, LARAMIE WY 82070
Address City/State Zip Phone
2821 REMINGTON S r STE #100, FT COLLNS CO 80525 970-493-4052
Contractor Address City/State Zip Phone
NORTHERN COLORADO AIR INC. 812 STOCKTON AVE, FT COLLINS CO 80524 970-223-8873
Contractor City of Ft Collins SAcs Tax 1I
Sales ear ilurrlf) rig rPt/wrLi7 by elt eonnart is
26862 _
Are you paying taxes here or by report? L9 Here ❑ Report
Are you paying with your b ust account? M Yes ❑ No
Is thit.a residontol of commercial project? ❑ Residential E) Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhorne (single family attached) ❑ Duplex
0 Multifamily (dpartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office D Office ❑ Retail
❑ Restaurant ❑ Other (explain) -
Is this building 50 years of age or more? ❑ Yes 5i No If yes, you may need to cootdct Historic preservation
if this is for a demolition permit, what year was the budding constructed? _
If pnoi to 1-975, you will need an asbestos assessment to subInd with this app/icatron.
Description of work REPLACE AC UNT IN GROUND IN SAME LOCATION
"If lawn sprinkler/backnow preventei, must list licensed plumber, If first-time A/C, must list licensed electrician.
Subcontractors: List thr rompany nine or Crty of Fr C'ullins license A
Elecuinan--- --- Plumber` Mcrhaiuidl_ Roarer
Other
I hereby acknowledge that I have rrad this application and state that the abova information is complete and correct T agree to
romply with all requirement, contained herein and rity ordinances and state laws regulatinq budding construction I know that a
permit is not valid until it has been paid and issued. ,
Applicant KARENA ^w -......... �.
Print Name KARENA HUNTWORK nature g HUNTWORK Date 06/01/2017
Sr _-_