HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 6/30/2018Fof Planning, DE lope t & Transportation
L CoLLins Fort Collins CD 80524 O. Box
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10000M1MIft—I Phom 970-416-2740 Fax 224.6134
OVER-THE-COUNTER PERMITS ONLY
i18 application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
Dernoltion (interior non-structural) ❑ Electrical Alteration (not service singe) ❑ Gas Lighter ❑ Gas Log
Heating Unit ❑ lawn Sprinkler C] Mobile Home replacement 13 Roofing 0 Sewer Una ❑ Photo -voltaic
Ventilation .13FWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
all awlicablejoldKmation on the application.
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Form we orgy
Incomplete applications will not be accepted.
Date Co(30j�g
lob Site Address Reps Value of Construction (labor, materials, Profit)
rm cam' ,�- rr 1355 eny/state P/I'+•vF.� ap Ph/�one/1 7�yj0 _T
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OVV tit �41-f-. J 21 ~ L! I70cant
Name Address City/State ZIP 331Z.
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ltir /4114 At. F Ad SD52
ntactor '///)') i' ^! lW-A*q Address city/state ZIP AV33
445 �i2VtCe P�4(A E S 2t..CE P� :? N4 CO
niradtor City of Ft CoUins Sales Taos #-3a ZOg Are you paying taxes here or by n)ortt? ❑ Here, ;"eport
saw taxmmofflsraw#WbyaG=&a� Are you paying with your trust account? . Yes ❑ No
s this a residential or commercial project? MResidentlal ❑ Commercial
residential, is ft 7i!Single. Farrdly Detached O CondWa wnhome (single f miry attached) . Ci Duplex
❑ Multifamily (apartment) 13 Garage
f commercial, is it 0 Bank 13 Bar 0 church D Hotel/MoW E3 Medical office O office D Retail
13 Restaurant 13 Other (explain)
s this building 60years of a" or more? ClYes O No IfyeS youmayneed tomntactt#5tvrfcPreseriabon
f this is For a demolition permit, what year was the building constructed?
,or cr- m r9as, you wR need an asbestos asgRo meat to sLAkWt mdh dad app/ imtb,7
lawn sprinklerybackfiow prevenber, must list licensed plumber. If first-time A/C, must list licensed electrician.
List the a npwyname orCly of Ft CaVhs%►se #
Pknrther Nle�iardmi Roars Other
hereby azlcmwledge that I have read this application and state that the above information is complete and correct I agree to
unply with all requirements contained herein and city ordinances and she taws regulating building cionstructiom I know that a
wniit is not valid untA It has been paid and issued.
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