HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 3/21/2017C
P1anNrig, Developmeurt Bc TMnSP0rtatiOn •
281 N. College Ave . - P.O. Box 580
'R®rt Collins Fort Cam, CO 80524
Phone g70-416-2740 Fax 22 -6134
MEWTHE-COUNTER PERMITS ONLY
This 8pPlic6fM is to be used to apply for the following permits only (check all that aPPIY� 13 Ai Conditioning
0 Demolition ('interior nonstructural) ❑ Electrical Altarraiion (not service change) ❑ Gas l;ghtar Q Gas Log .-
❑ Heating Unit ❑ Lawn Sprinider C3 Mobile Home replacmerlt ❑ Roofing 0 Sewer Line - 0 Photo -voltaic
O Ventletior�rater Heater 0 Water Line ❑ Wood/Pellet Stove (must be EPA certified. provide make. model and
manufechuer).
Complete all apoiieable on on the applfcatton. Incomplete applications will not be accepted.
Application # I 0 Date
Aorofiku use aelY
Sob Sll a Address (nmx*od) Value of Construction (labor, mabensls, PME)
Iftr� "Rv�[Itr� r �i l ( f3 202
Adam 1355 . City/5t a vr. ✓' Zip Phon Ig?? v
Address City/State Zip Phone
r,;05!-:V
• %�.�x ifja2 C S dot p 9�-33! i
Phone
Contractor Lic # Addn s5 Cliy/State zip
fZ4'.N64
4 c "
Contractor City of Ft C0111% Sales Tax # 3k.2v j Are you paying saxes here or by reports 0 Here Veport
Salestaxnum�ernvrqusmoYabaorraaamvs Are you paying with Your trust account? )'Yes 13 No
Is this a residential or commercial prate NrRPsidentfal 0Commercial _
If re sidentlei, Is it if single Ferrltly Detached ❑ Condojwwnhorn (sln91e 14MOV attached) O Duplex
C} MuWamUy (apartment) O Garage
If omwer cial, is it O Bank ❑ Bar C3 Church 13 Nobel/Motel E3 Medical office D Otflae D Retail
❑ Restaurant ❑ Other (exptam)
Is this building 50 years of age or more? O Yes 13 No Ify25, yrt! rraayre�d to mnbctH Prn�bhn
if this is for a demoltdon permit what year was the building mnstrucbW
If poor W 1975, ytw wdN need an ads a:�essrnent ib submlf mph Ohrs apgNcs�'oa
l DMCriptiori of work r r -e
I
*If lawn sprinldw1baditw "enter, pwst list ocensed plumber. If first-time A1C, must Ilst ficumd electrician.
subeolm c%ors: list dvecomplenyn�meorGXyoffiColl2riK�rBe#
EWb'idaa Pbrmbes Meftnrml Rooie Other
I hereby acknowledge that I have read this applicator► and state that the above Irdb matron is i
wmply with all tequirernents oziWned herein and city ordinances and slate taws regulating bu
permit Is not valid until it Ras been pald and Ssued.
I
WNW
Bte and correct I agree bo
construction. I know that a
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