HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 1/1/2016Jan 1416 09:22p Ellmann Service Co
9702233324 p.1
Planning, Development &Transportation.
City of 281 N, College Ave. - P.O. Box 5130
CollinsFor-1-Collins, CO 8DS24 -
Phone 970-416-2740 Fax 224-6134
€ VER-THE-COUNTER PERMITS"ON Y. ..
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) O Gas Lighter ❑ Gas Log,
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation 9ftater Heater .❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, proAde make, model and
manufacturer).
complete all applicable information on the applicatIncomplete aPPlicatio w ll not be accepted.
Application #! Date
Foromcle use an/y
Job Site Address (required)
�� a
G, Address f 35S
f4. 1.
Value of Construction (labor materials, profit)
Cty/State�Pilri/.P�'� zip Phone
A r 7i,, e _n go222 -= -
plicant Name Address city/state Zip Phone
�x �=�2irCiisGa-=r:� G f v-: i1v-251-3`3ii
Contractor Uc # Address CiryJState Zip Phone
!if �.'yt.�.+�nJ � i? f�..L fu•'-=: �l { = f f � � r��''t�'
Contractor City of Ft. Collins Sales Tax # 3_-Sr�vk— Are you paying taxes here or by report? ❑ Here Wkeport
saw tax nut f is required by mnUaclors Are you paying with your trust account? ®'Yes 0 No
Is this a residential or commercial. project? M-Residential ❑ Commercial_
If residential, is it: J(Singile Family Detached ❑ condo/townhome (single family attached) 0 Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: [IBank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? D Yes CI No Ifyes, you maynleed to contactHistnricPreservadon
If this is for a demolition permit, what year was the building constructed?
1fprior to 1975, you W71 need an asbestos assessment to submit with this application.
Descrintiori of work 0n &a j j¢ � U' G�C� C.�� 4` 1 � .
r 1
*If lawn sprinkler/backfiow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
S ubcontractors: List the company name or Qy of Fr Collins Iicense I
I
eet-vidan Plumber mechanical Roofer Other
I hereby acknowledge that I have read this application and state that ;be 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.
Appffi
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Date th hi,