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HomeMy WebLinkAbout4900 E BOARDWALK DR - APPLICATIONS - 2/17/2016Mar 0416 03:02a Ellmann Service Co 9702233324 p.2 'F6C1tYC S Planning, Development & Transport*bon 281 N. College Ave .- P.O. Box 580 - Fort Collins, CO 80524 Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY. .. This application Jr. to be used to apply for the following permits only (cfleck all that apply). ❑ Air Conditioning * Demolition (interior non-structural) ❑ Electrical Alteration (not service change) Q Gas Lighter 13 Gas Log , ❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement Q Roofing ❑ Sewer Line ❑ Photo voltaic O Ventilation Dater heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make. model.and manufacturer). Complete all applicable lnfonmatlon on the application. Incomplete applications will not be accepted. Application #_ L2> 100 t ( CO � Date Aor office am only Sob Slfie Address (required) Value of Construction (labor, materials, profit) 44 — $ a Address R)5 aty/State Vev' 'Zip Phon v f e►r o u r c� C D 222. 31 I• -191go a Applicant Name Address City/State Zip Phone contractor tic # Address City/State Zip Phone J�f=r fit �sff �1?/!!¢fG-•M i..`�=7 / l i =¢f� I � i.�si �7f� 5��?:2 �i�fyl7T )�.ii i•`'t Contractor Cry of Ft Collins Sales Tax 3k!: <ur— Are you paying taxes here or by report? ❑Here Report I Sales taxnumberisreou�+:dbyaacorrtractars Are.you paying with your trust account? JZYes ❑ No Is this a residential or commercial project? gResidentlal ❑ Commercial , If residential, is •it: 0Srngie Family Detached M Condo/wwnhome (single family attached) ❑ Duplex FJ Multifamily (apartment) fl Garage . If ow irneraal, is t: ❑ Bank © Bar ❑ Church ❑ Hotel/Motel ❑ Medical office 0 Office Q Retail ❑ Restaurant ❑ Other (explain) is this building 90 years of age or more? CI Yes to No ifyes, you maynead to contactHistork Preservation If this is for a demolition permit, what year was the building constructed? If on&:to 1975, you W11 need an asbestos assessment to submlt WV? thisavplicatron. Description of work Y" *If lawn sprinkler/backiiow preventer, must list licensed plumber. If first-time AJr, must list licensed eiectridan. Subcontractors: List the company name crQyofRCof%w&&is&r Electrician Plumber f+te&anior Roorer Other — I hereby acknowledge that I have read this application and state that the above information is eornplete and correct I agree to comply with all requirements contained herein and city ordinances and state laws regulating building construction. 2 know that a permit is not valid until it has been paid and issued. Applh Print: N _ N 1