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HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 9/29/2016Planning, Development & TMnsQarialiion r 281 N. College Ave.- P.O. Bmc 58D %A o - ' � Port Collins, CO MS24 ; Phone 970-416-2740 r 22-4-6134 OVER-THE-COUNTER PERMITS ONLY. .. This application la to to used to apply for the following permits only (ciieck all that apply). ❑ Air Condifionirig a DernoWon (interior non-structural) 0 Electrical Alteration (not service change) 10 Gas lighter O Gas Log .. Urlrt CE Lawn S rinkter Cl.Mabl�e Home replacamerit 0 Flooring 0 Sewer lane - D Photo -voltaic 0 Hedng p O Verrfilatior Hater Heater 0 Weer Line 0 WoodlPellet Stove (must be EPA certified, provide make. model.and rnanufa�r). - Complete all applicable Information on the application. incomplete applications will not be accepted. Application #, 9WD0(D Da� Forofc,ee &w Gray Sob Site Address (rltlTr - Value of Construction (labor, materials, profit) Address �3rJ Cray/state Vt�' -Zip Phon L -'l?v 01 0 5 Y 10 L Address �yls� zip Phone Applicant Name 2� Address City/State, Zip Phone Contractor t.ic # . 1 l yfl Cf '� a SJ�n?rZ Contractor C.lty of Ft Collins Sates lax # �cs�-- Are you paying taxes Isere or by report? 0 HereReport Sales taxnum�errrregr�ira�braffCVn ed= Are you paying with your trusC account?" t3 No Is this a resldeniial or cornmemial prroject Residential 0 Commerdar. _ 1? Duplex if residential, is 'rk: 0 Single Family Detached, © Condojtownhom6 -(single family attached] 13 MuitifamilY (apartment) 0 Garage JfQ=Merdal,!slt:* 0 Bank Mar 0 Chumh ,.0 HoteWM0t'el E3 Medical office-Dofa 13Reca0 13 Restaurant 0 other (explain) Is this building 5o years of age or more? D Yes; ONO. Ifyps, yvu may need to ciamaCtHistor1CPr a*n If this is for a dery saloon permit:,, what year was the building constructed? Il°pnier io 1975 yeti will need an s aMessmenf fc.subm/f Visit this 3pprCVtb1L oesmptiart of worts *If lawn sprinrder/bactdIow Amventer, must 16t licensed plumber. if fast -time A/C, must list licensed electridan. -Subcontractors: L& b`re coMpanynarne or Cdy of Ft Collins prise a I t.[ewdan Plumtiar i4echanical RooFer Othat. _ I hereby admowledge that I have read this application and state that the above k&rmstion is coeiO] and correct i aWW t.O comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a permit in not velld urfdl it bas been paid and issued. Applicant.- Date q124711(0 Print Narna:nnrS1 Sig L'd VZ£££ZZ0L6 00 901AJBS UUBW113 dtZ: L L 9L 61, 100