HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 5/14/2018^-L _ -Z
Pi M M I7evelope nt & Transportation
-)at m_ r-nilpap Ave P.O. Box 580
4iL v+
ort Collins Fort CollIM 00 80524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
T
is application Is to be used to apply for the following parmits only (check all that aP(ty)• O Air C�d�nIng
❑ Electrical Alteration (not service change) 17 Gas Lighter ❑ Gas Log
*
❑
Demolition (interior non-siructural)
Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
bs EPA certified, provide make, model and
❑
Ventilation Water Heater 0 Water Line ❑ Wood/Pallet Stove (must
rwfacbm).
all applicable information on thea�pplloation. incomplete applications will not be acceoted.
Application
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# � 1 GI Date
ForoA%h3 0
Value of Construction (labor, mated* prohV
Sibs Address (reqLftW
VIOL/M t35S atyfState v ww Zip Phone o Owner-
`7 CO 9) 2zz 371- gha
:r%r u . C
PhM
Address CitylState Zip33+Z-
pliant Name
IN /41/4 g . 6kt3D52
,
ntractor '1/m �^J f j'l Address CitY/Stam 33
El2v�GC� / f l -u zuc - P� n[S Co
r CIty of Ft. Collins Sales Tax #� � Are 'you paying taxes here or by reporW. ❑ Here ..8ep�
tax numberkm0Avdbya!law&v Are you paying with your trt�t account? , Yes ❑ No
this a residential or commercial Projed? XRegdentlal ❑ Commerc�t ❑
f residential, is it: Rlsngle, Family Detached 0 Condo/townhome (single family attache MOM
❑ Multifamily (apartment) ❑ Garage
f commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ HCWVMDW ❑ Medical office ❑ Office 13 Retell
❑ Restaurant ❑ other (explain)
s this molding 50 years of age or moue? ❑ Yes t7 No !f yes ybu maynaed to iliac Pre�rhadav!
f this is For a demolition permit, what year was the building wnsbucted?
prior to 1975, you WW need an aabesbas MMIMM t !n subMt iaddi i& aP,7Ik9U0fl
escripciort of work
r/1
If lawn sprinlder/baddlow pmvent+er, must itst licensed Plumber. If f M time Ali must FA kensed eleC�n.
udw.mractora: [cstthe cwnwnynaine orCMycfRCawwffmw #
oectdclan- PMnnber _ - Med4animi otht°a'
hereby acknowledge that I have read this application and state that the above intormation is complete and correct I agree m
ply with as requirenien contained herein and cLy ordinances and stela laws regulating building construction. I lawn that a .
It Is not valid until it has beam paid and Imued.
t` a'm���n,,h� Date
£'d 9LtI0-Z9t'-0L6 Auodwooeoinjesuuewlie d6£:90'81,66unf