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HomeMy WebLinkAbout4900 E BOARDWALK DR - APPLICATIONS - 2/22/2016Mar 0416 03:01 a Ellmann Service Co 9702233324 P.1 Planning, Development & Transportation . tri•�r o•� ZBi N. Coliege Ave. - P.O. Box 580' F&tcollins Fort Collins, CO OGS24 - - Phone 9MA16-2740 Fax 2246134 OVER -TIDE -COUNTER PERMITS ONLY .. CG This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning Q Demolition (Irnerior non-structural) it Elecvical Alteration (not service change) ❑ Gas Lighter q Gas Log ❑ Heating Unit ❑ Lawn Sprinkler © Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic ❑ Ventilatiov. I ater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certCfied, provide make, model.and manufb=rer). I' Complete all applicable information on the application. Incomplete applications will not be accepted. Application *___E Date For office use only Sob Sifie Address (far-rlulrad) Value of Construction (labor, materials, profit) Address 3�� Gtyj5tate Y4t''' 'Zip Phond?7 v a �0 [ 32 r. o Applicant Name Address City/State Zip Al Phone _ �+r,. ��! i •Jy .r � •r.: '%'= f �i i"�G�.e f�C d 121:� 2— Cofntractor Lic # Address City/State Zip Phone 1i `"r il'1 / so C:6 �' J .r. y// f ri'/t�7 Jilt►?h SiY/�?rA- "X`2 Contractor City of Ft; Collins Sales 1 ax 3Y. t c:�— Are you paying taxes here or by report? ©Here Report ,Sales taxnumberis trWred byeff cortGad0rs Are you paying with your trust account?- JgYes ❑ No Is this a residential or commercial project? oResidenfial ❑Commercial If residential, is It: Nf Single Farrilfy Detached ❑ Condojtownhome (single family aVachedj . ' 0 Duplex ❑ multifamily (apartment) ❑ Garage ifaoRrtiwdal, is it., ❑ Bank © Bar ❑ Church ❑. Hotlel/Motal ❑ Medical office © office C] Retail . © Restaurant E3 Other (Wialn) Is this building SG years of age or more? ©Yes ❑ No Ifyes, you fnayneLed to mntactf�l�k7ifcPreservab&on If this is for a demolition permit, what year was the building constructed? Ifprior to 19n j6U Will need an asbestos a"emnant fo submlt KYM this appllWtion. Descriptiorf of *If lawn Sprinklerlbackilow preventer, must list licensed plumber. If firsti 5me AJC; must tip licensed eWctridan. Sub©ontractorm i1stOm companyaame orGly eP2 Ch insiic'ense . SaEtidan Plumber Mechanfcaf Roofer Other i hereby a&nowledge that I have read this application and state that the above Information is -complete and correct. I agree to comply with all requirement'_s contained herein and city ordinances and state laws regulating builcling construction. I know that a permit is not valid until it has been paid and. issued. Applii Print = E E