HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 7/7/2017C
Planning, Development &haesportd ion
tf 261 N. College Ave. - P.O. Banc 580
�F -- Fort Collins, CO 8D524 .
Phone 970-416-2740 Fac2i"134
OVER -TIDE -COUNTER PERMITS ONLY
This application Jr. to ha ua®d to apply for the following permits only (ciiack. all that apply). 0 Air Conditioning
0 Demolttion thartor non-struemral) M Electrical Alteration (not service change) ❑ Gas Lighter Q Gas Log
l7 Heating Unit 0 Lawn Sprinkler EI Mobile Home replacement ❑ Roofing 0 Sewer Lino - 0 Phctoaroltaic
O ventil�tionAZ<Afader Heater ❑ Water line 0 Woodipallet Stove (must be EFA certified provide make, model.and
manufacturer).
Comph#9 all applicable i nthe api;Ho ton.
Application # ��o✓
incomplete applications III°°t be accepted.
Date's 1('�
. _ ..,
Job Site Address (rt:qulr4 Value of Construction (labor, mated&, prot'1)
AAM .'R� lydu)a I 1-3
Address l355 f�tyl5tate very- Mp PhonR v
Crier aY c� C: Zap. 3?1-1?0
Applicant Name Address ZIP Phone
'`f% raF� a i tTy %G.�.. '�=� /" �? SG•B� D � C- .� �l•' �v ��—�3! �.
Phone
Contractor i_ic # Address cY% zip
IL .� . �� •� � � � qm 9 5 .;��rz S i���z S;�it:!� S� �.�
Contractor City of Ft Collins Sales Tax # 3k {r?d' Are you paying tams here or by report? ❑ Here ($'Report
Sales taxr>ZrmbPmisrequ6rad by mrmaators Are you paying with your trust account? WYes 17 No
is this a resldent3al or commercial project? W-Resrdentfal ❑ Commercial _
If msiderrtlat, is it Xf Single Family Detached 17 Oonde/townhome (single farrniy attached) 0 Duplex
El Kulf3family (apartment) - 0 Garage
itcom aerdal, is it: 13 Bank ❑ Bar ❑ Church ❑ Watel/Motel 0 Medimi office 0 Office Cl Mall _
0 Reslaurdrlt 0 Odw (e iplailn)
Is this !wilding 50 years of age or more? O Yes 0 No irle4 you maned Lo avzlactfllsto& Pmeservabbn
If this is fior a demolition permit, what year was.the building aonsbuded?
FfpriortoY9T5, yvu wIll need a7ashmtw as,cmmf N"Amit w4h this a Happlltai7Ln.
*If fawn gnInkler/backflow preventer, must list 6omsed plumber. If fhst-time A/C, must Hst 11censed elechiclan.
,subeontractotm or mil' cfRCo/Giss G�zre .
ioar� f�lurn '� rAedlanlmi Rooter
Other
I hereby acknowledge that I have read this applimllon and state that the above Information Is complete and correct I 39M W
.comply with all requirements mntalned herein and city ord►nances and state laws regulating Widiag construction. I luuow that a
permit is not valid until it has been paid and issued.
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APPH
pr;nt tVa,ne lffi7'n�/5 G ..,.o:..a.slgn�r/ Date "'+f
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