HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 9/12/2019Cttyof Planning, Development, a Transpart orn Servfcw
r,F6rt lies Community Development & Neighborhood Services
t` 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 foilovdng permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical AReration (not service change) El Gas Lighter ❑ Gas Log
❑ Heating Unit •❑ Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line 13 Photo -voltaic
❑ Ventilation l� Water Heater ❑ Water Line ❑ WoodiPellet Stove (must be EPA certified, provide make, model and
manufacturer/.
Complete all applicable Information on the application. Incomplete applications will not be accepted.
Application # N vl I 'D Si
Foroffrce UM only
Date Cl -11 l Ci
lob Site Address (required) Value of Construction (labor, materials, profit)
�4°I00 c�ocdwG1Y, t7r. lh� �- O -2 0 so,
Property Owner Name Address City/State Zip Phone
Mica o� r fA r 1 Dr.F G 52 Cn0. 2 -�19q
Applicant Name Address City/State Zip Phone
Contractor Address City/state Zip Phone
Contractor City of Ft. oillns Sales Tax # you paying taxes here or by report? ❑ Here ❑ Report
Safes tax numberIs d byall contractors Are you paying with your trust account? Yes ❑ No
►o L7
Is this a residential or commercial project? )2fikesidentiai ❑ Commardal
If residential, is it: ❑ S gle Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
ultifamily (apartment) ❑ Garage
If commercial, Is it: Bank ❑ Bar 17 Church Ci +Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes ❑ No if yes, you may need to corrractHfsrortcPrEservadon
If this is for a demolition permit, what year was the buiiding constructed?
Description of work Q G O
*If lawn.'sprinkler/baddlow preventer, must list lioensed.plumber. If tied- time A/C, must list licensed electaician.
Subcontractors: Ust the company name orQyofFt Cokasllcense rk
Dectridart Plumber Mechanical Roofer 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 unfll it has been paid and issued.
Applicant: Print Name: aUCA� Signature Late. CA • -
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