HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 10/18/2018Piarwdng, Dwelapnaant & Transportation
city af 281 N. College Ave P.O. Box 580
F�/L b Collins
Fort Collins, CO BM4
Phone 970-416-2740 Fax 224.6134
OVER-THE-COUNTER PERMITS ONLY
�hEs application Is to be used to apply for the toilowing permits only (check all that apply). ❑ Air Conditioning
0 Demolition (interior non-structural) 17 ElecIrloal Alteration (not service change) ❑ Gas Lighter 0 Gas Log
0 Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
O Ventilation .18-Water Heater 0 Water Une O Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer). .
Complete all applicable Informatio
n
on the application. incomplete applications will not be accepted.
application # P)ICOD I Date
forefflee asie onV
Job
SiEe Address (e4ubedl 4" 31D I�nao9 mat82roft)
e Owner dress 1355 uty/state r'ivw� Zip PhO -
�i`w'°wa�-C" �'
- - ) c - ;=i yr r v �22Z 37t - 9l'ta
ApL47 V.
plicantName Address City/stew Zip
h3312-
I¢6�N �`i/'t h It1S gO52
Contractor 0//Y1 1;9^/&/ OW Address City/ate Zip
:Contractor
City of Ft. Coins sales Tax #,3e Z08 Are you paying taxes here or by report? ❑ Here ;6 aeport
Is�aesca�rnurrbaris►e�uneaayaaawro Are you paying with your bust accorahCt . Yes O No
Is this a residential or commercial project? XRes[den1Jai O Commercial
if residential, is it: 72f•Single Family Detached O Condo/townhome (single family attached) O Duplex
❑ Multifamily (apartment) O Garage
if commercial, is it ❑ Bank ❑ Bar ❑ Church O Hotef/Motei E3 Medical office L7 Of im 0 Retail
0 Restaurant 17 Other (explain)
Is this building so years of age or more? D Yes O No 1fm you mayneed tb contact H/stan`cPreWrrratfon
If this is for a demolition permit;, what year was the building constructed?
j if prior to 1975, you will need an asbaMw asrssma7tW submit fflM this appAiwzr n
Description of work
*If lawn spr[r>ider/baddlow preventer, must fist lied tbumber. If first-time A/C, must fist fiowised electrician.
SubcNybzctDm LzttinewnWwyrrameorCRycfftColtiRsGcertse#
e.arwan P1umber Medwic Roofer
Other
I hereby acknowledge that I brave read this application and state that the above kftirmation is complete and correct I agree rn
comply v th a0 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.
Print f42A
Date Ahild
L-d 9LtO-Z9t-OL6 Auodwoo eoimes uuewlle d90:£0'9LbLAoN