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HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 9/14/2016 (2)Sep 2516 09:28p Elimann Service Cc 9702233324 p.7 Planning, Development & Transportation . Cif of 281 N. College Ave .-P.O. Box 580 Flirt Collins Fort Collins, CO 80524 _ r /'�'' Phone 970-416-2740 Fax 21+6134 OVER-THE-COUNTER PERMM ONLY C� This application is to be used to apply for the following permits only (check all that apply). ❑ Air Gondlil"oning ❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) 0 Gas Lighter Q Gas Log © Heating Unit © Lawn Sprinkler ❑ Mobile Home replacement 0 Roofing ❑ Sewer Line ❑ Photo-voilaic O'Ventilatior l later Heater ❑ Water Line 0 Wood(Pellet Stove (must be EPA certified, provide make, model_and manufacturer). - - Complete all applicable informadon on the 20plication. Incomplete applications will not be accepted. Application # j b I � () � C, � I Date - TW For afte use only Job Silo Address (raq =9 �,(1Lt�o�l�l+t:$�. Value of Construction gabor, materials, profit) Wafj�Address R55 . Cty/state v'l ✓' 'Zip Phcm t% b �7 stir o ` y 222. - [' Applicant Name Address City/State Zip phone �y��r,. �� s �_!.� %C••c•.�,�r :rt � i �r '� rit�r"iG��e! � f .- ter..- , �� � ��v 2�� •-.3�}t .7.� Contractor Lic # Address City/State Zip Phone fi�� rl�tt�.+�.W` F`. �, o-•a �'� �: �%'-Ff / � � ���fd 5/�nfz $,s/r:;� .>��. ��s Contractor City of FL'Collins Sates Tax # Sk.:;zojr— Are you paying taxes here or by report? 0 Here tKReport Seim &wawnbw&requhvdbya#caatractar$ Are you paying with your trust account? 'RNes ❑ No L9 this a Mlderitial or commercial p�qject? 91keddenttal ❑ Commercial _ If residential, is it OSingle Family Detached II Conde/townhome (single family attached) Q Duplex 0 Multifamily (apartment) 17 Garage . If c=mercial, is it: 0 Bank LI Bar ❑ Church ❑ Hotel/Mobal ❑ Medical office © Office ❑ Retail ❑ Restaurant ❑ Other (explain) .Is this building 90 years of age or more? 0 yes 0 No rfyes youmayrreed tg CglrtactHISWCPreserr gon if this is,for a desnoll#ion permit, what year was the building constructed? Ifflnor to 1975, you W1# need an asbestos assessment to submit with thisap�efror� Description of f2i *If lawn sprinklerlbackFlow preventer, must list licensed plumber. If first-time AIC, must list Ircensed electrician. Subcontractors. Lfst bf a ca+r4e3nynaime ar Gfy ofpeCollars ff- aW,9 _= ElaetFif an- Ptunnher "� Mechanical ROOM _ „ Other�� I hereby acknowledge that I have read this application and state that the above Information is'compjete and correct 1 agree to comply with all requlrements contained herein and city ordinances and State laws reguiaiing building consiructlon. I know that a Permit is not valid until it has been paid and Issued. Appil Data ?rintme:�//�r7!J.�f Sin I