HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 8/2/2017Planr4ngr DeveloPtnent &TramiF0"b0KQA
gat N_ nonwe Ave _- P.O. Box 580 .
? , o ins Fort CeMins, CO 86524
Phone 970-416-2740 Fa of 224-6i34
OVER-THE-OOUNTEit PERMffS ONLY.
This application is to be used to apply for the forlowing permits only (Neck all that apply). 0 Air Conditioning
n not service change) ❑ Gas Ligirier 0 Gas Log
CIDemoNtlon (irtteriar non-sbucwraii 17 fi Alteretio
0 Heating Unit 0 Lawn Sprinkler 0 Mobile Home replacement E3 Roofing ❑ Sewer line 0 Photo -voltaic
❑ Veniia#lor oeler Heater ❑ Water Line 0 WocdlPellet Stove (must be EPA c rtitted, provide make. model and
mamdsclur&r
Complete all applimbie iniormlMon on the application. Incomplete applications will not be accepted.
Appllafd n # 12A +5Z Date g/ �- /I —
Sob SIM Address (AWURWJ Value of Construction (labor, materials, profit)
U� . 2
Address f 355 CftY/ vt''�p Phoru v
• b �p � 0 ? (� 2?-2• 3? f -fir?(3
Applicant Name Address CitY/State ZIP Phone
u [ u('C —C CO 4e j?o 253
Contractor UC # Address City/State Zip Phone
`��M�rr � .� f� yi S i ��•,Tr 5�.z S�.r.� Sr��
Contractor Cky► of FL Colikis Sales Tax # 3k: cv,F— Areyou paying taxes ire or by report? ❑ Here DEReport
SafestaarrnrmlrerlsnlgtrbaorbY� +trac0:vs Are you paying with your Mist account? 9yes ❑ No
is this a residenft or commerdat projecC� �C7Re rCa1 ❑ tOomrrrerdal
If residential, is it 0SIngle Faintly Detached o condo/townhome (slrrgie family attached) C3 DUPteic
Cl Multifamily (apartment) Cl Garaga
I4mmoerdal, Is Fc 0 Bards 0 Bar 0 Church ❑ IiOWMotel ❑ Medical office 13 Mce E3 Relafi
0 Restaurant 0 other (explain)
Is this building 50 years of age or more? M Yes ONO Ifytes, you mayl7eed m m�ct/i1stG�ric Pr�ar vabron
If this is for a riaatoiltion perrrtik, what year was the building aonsbvcMd?
Ifpriar to 19n )w WAV need an asystas ammrera=tn.wbm/t rvlbri this app/fcS&M
Desa•iptfon of work rrm Qr Da4w bleaAr,
*Ir lawn sprInIderibaddiaw omm ter, nest list licensed piurrJw. If firstrdme A/c, meat list tbmerecbdaarr.
Subcontractom trstthetwnpte Ynmeorclyofaca7MAW)"
t3echr[cien Phardier MedwkaL. Roofer Otis'
I hereby acknowledge that I have read tfds wpib== and slats that the above trrTormation is compiate and correct I agree to
oomply with all reWremwft contained herein and arty ordinances and Mft laws regulating building =mtrudkHL E know Umt a
permit is not valid unta it has bow paid and Nsued.
Print t lr L..�oz��[Si / l Date 2 _
Z d 9I40-Z8ti-OL6
Auodwoo eomies uuewlle d60 90'L 6 8Z AoN