HomeMy WebLinkAbout4815 BOARDWALK DR - APPLICATIONS - 5/9/2017 (3)Uu N�
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at of Planning, Development & Transportation
F% t . 281 N College Ave P O Box 580
Ort �ol`�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) ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not sery ce 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 # Q 1-462-4 23
For afire use only
Date 5/9/2017
Sob Site Address (required)
Value of Construction (labor, materials, profit)
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Property Owner Name
Address City/State Zip
Phone
SECUR CARE STORAGE (AVERY HERRERA) 4815 E BOARDWALK DR FORT COLLINS CO 80525
303-842-4656
Applicant Name
Address Oty/State Zip
Phone
KELLY CANNON 2690 W MAIN ST SUITE C LITTLETON CO 80120
303-816-1888
Contractor
Address City/State Zip
Phone
INFINITY RESTORATION
2690 W MAIN ST SUITE C LITTLETON CO 80120
303-816-1888
Contractor City of Ft Collins Sales Tax #
Are you paying taxes here or by report?
I: Here ❑ Report
Sales tax number Isrequlmdbyall mntractom
Are you paying with your trust account?
❑ Yes IXNo
R-1865
PLEASE CALL ME FOR PAYMENT KELLY aQ 303-816-1888
Is this a residential or commercial project? ❑ Residential CKCommeraal
If residential, is it ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel
otel 13 Medical
edi STOice 13 STORAGE Retail
UNITS
❑ Restaurant iR Other (explain)
Is this building 50 years of age or more? ❑ Yes R No If yes, you may need to contact Histonc Preservation
If this is for a demolition permit, what year was the building constructed?
Ifpnor to 1975, ynu will need an asbestos assessment to submit with this applicabon
Description of work
*If lawn sprinkler/backFlow preventer, must list licensed plumber If first-time A/C, must list licensed electrician
Subcontractors List the company name or Oty of Coffins license #
Electrician Plumber Mechanical Roofer ?'-6U 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
KELLY CANNON
Name
Prinntt NName
Signature 5/9/2017