HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 3/2/2016Mar 13 16 08:23p Ellmann Service Cc
9702233324 p.1
Planning, Development &Transportition-
clty p-f 281 N. College Ave . - P.O. BOX 580'
> Fort Collins, CO 84524
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- Phone g70-41 6-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY . ..
This application Is to be used to apply for the following permits only (clleck all that apply. 0 Air Conditioning
0 Dernoli on (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter D Gas Log
0 Heating Unit ❑ Lawn Sprinkler Ci Mobile Horne replacement D Roofing ❑ Sewer Line - ❑ Photo-volwc
p'Ventilstioi' Eater Heater 0 Water line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model•and
manufacturer). -
Complete all applicable Information on the application. Incomplete applications will not be, accepted_
Application # I Co G 1 H 0 Z Date -
For ol%usE only
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lob Site Addmss (re+qulred)
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Value of Construction (labor, materials, profit)
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Address 1355 . Gity/state vtv-
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Contractor City of Ft:. Collins Sales Tax # 3 :�20i Are you paying takes here or by report? ❑Here Orkeport
-Wes tar numberlsrequired6yallconaactas
Are you paying vylth your trust account? 'Yes
❑ No
is this a residential or commercial project? gResidentiai [3 Commercial ,
If residential, is it:: Single Family Detached ❑ Condgjrbwnhome (single family attached) Q Duplex
Q Multifamily (apartment) Q Garage
if c=merdal, is it: iJ Bank 0 Bar LI Church 0 Hotd/Moiel 13 Medical office 0 Office 0 Retail
0 Restaurant Q Other (explain)
rs this building 50 years of age or more? ❑ Yes D No Ifyes, you mayneed t0 contact Hi , 0ffCRreservra60n
If this is for a demolition permit; what year was the building constructed?
lfprior to 1975, you taill need an asbesos assessment to.submit wl i this awhi:abon.
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*If lawn sprmklerybadd low preventer, must fist licensed plumber. If ftst-time AIC, must list licensed electrician.
Subcontractors: LEA iecom nynameorGlyoflctCoffasGcenseT
EleWdah Plumber -- me&w[cal Roofer Other
I hereby adenovuledge that I have read this apprication and state that the 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.
Appllcant"
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