HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 5/8/2017May 01 17 10:04p Ellmann Service Co 9702233324 p.4
C
Planning, D,Veloprrltant 8L Transpo
on •
cityof
281 N. College Ave .- P.O. Box 580
-
,CoWn5
o
Fort Co111ns, Co 8052.4
Phone 970-416-2740 Fax n -6134
OVER-TH
-COUNTER PERMITS ONLY.
This application is to be used to aPAIY
rthe following permits only (check ail that apply). ❑Air
Alteration (riot service change) ❑Gas Lighter 4 G
nditioning
Log .
Demolition Qrtterlor rton-structural? ❑
0 Heating Unit ❑Lawn Sprinkler ❑
actrical
Be Home repiacsment ❑Roofing ❑Sewer Line ❑Photo-
itaic
0 ventifatior eterHeater ❑ Water
ne ❑ Wood/Psilet Stove (must be EPA certified, provide mal
e, model and
manufacturer).
Complete an applicable In ono
the application. incomplete eppliGatione will not be s� I
d.I
Application # J3110Z-4�6
Date
fbrofte raa onh'
value of Conaru' ctlon (labor, mated
, profit)
Sob Site Atfdress (regv6ed)
:::]
1 v
ddress 1355 &Y/Stat� vtr' zip
L ar o �1311r I (7 22z.
37 P -fir?0
Applicant Name
ddress City/State Zp
_
S
n
Phone
o 29�-3i1 i
pr,, � i Lr• r%fin .4�+ �sr
'%ate-' Ci��E i "' . ^
Contractor LIC #
ress eaylscare Zip
Phone
Contractor City of Ft. Collins Sales Tax
3kmod— Are you payfig taxes here or by report? ❑ H
Are you pig vAth your trust account? WY
'Report
fl No
-caw MrnwtertsraWft dbraDm tradam
Is this a residential or commercial project?
is It. B single Family Detached
Residential ❑ Commercial
❑ condoltownhome (single family arsached) ❑ Dup
If residential,
Q Multifamily (apartment)
❑ Garage
If curnrnerciai, is 1tr ❑ Bank ❑ Bar 17
Church ❑ HOWIMobel ❑ Medial office O Office ❑ Retall
Q Restaurant ❑
Suter (explain)
Is thisbueding So years of age or more?
M Yes ONO IfM ICU flWn ed m mnlacfHlsmrlc
If this is for a demolition permit, what
Ifprior to;97$ Mr/ 09 need an
r was the building construcMd?
amewnerrt to wbm/t wlk5 this apPi T&A
DesWptlort of work
Yne Y-
"
*If lawn sprinider/baddiow preventer, mum
1st i d plumber. If nrst-ime AIC, rturst list rid electrician.
301,eontmcum LM bhp mrnpanyn8me or
ctyafjc Cca s&Msa jF
Becbician Plumber
medonical Rooi er oth
I hereby acknowledge that I have read kris a
ndication and state that the above Intbrmatlon is complete and
I agree bo
comply witlt aI requirements cortta ned herd
i and city ordinances and state laws regulating building constrt on.
know that a
permit: is pot valid =tR It has been paid
and Issued.
Applicants
Pit 1a�• n.o S G
— ' `_�
sign ,�_ Date
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