HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 1/23/2019Planning, Development, & Transportation Services
F®rt CoRins Community Development & Neighborhood Services
281 North College Avenue
Fort Collins, CO 80524 Main: 970.416.2740 Fax: 970.224.6134
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 service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit Q 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).Yk
Complete all applicable on the application. Incomplete applications will not be accepted.
Application # Iy I g0—ClL99 Date
For office use only
Sob Site Address (required) Value of Construction (labor, materials, profit)
°I 1 k W4 130 6 2 0 °a
Property Owner Name Address City/State Zip Phone
M« 000 '&qid WWY,Dr r C, 8057.8 223 • L4G Lli
Applicant Name Address City/State Zip Phone
11a'110 ?luinnb oa GO Ghe5tn U �Ork Collms "aS2L- L4By -i (V&0
Contractor Address City/State Zip Phone
Contractor City of Ft. Co ins Sales Tax # Are you paying taxes here or by report? ❑ Here ❑ Report
Sales tax number is required by all contactors. Are you paying With your trust account? XYes ❑ No
t0179
Is this a residential or commercial project? Vesidential. ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: Bank ❑ Bar ❑ Church O- Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes O No Ifyes, you mayneed to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
Description of work 1te04 GC -Ed `40 UC'Mn n1 Ub4
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
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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: //_���
Print Name: _ VACA �l.1 4 Signature LSL�1 lC Date' ` 1
Revision dale 20017