HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 10/22/2018Asa:.j__ -Pfab` En e.�aS e Ls
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�� 3 �� -��s Community Development & neighborhood Services
284 North Coliece Avenue
FoIL Collins. CO 80524 Main: 070.416.2740 Fax 970.224.6134
OV, ER-THE4C9OUER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log V
❑ Heating Unit ❑ Lawn Sprinkler 0 Mobile Home replacement ❑ P.00fing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation A Water Heater 0 Water Line Cl Wood/Pellet Stove (must be EPA certined, provide make, model and
manufacturer).
Complete ail appiic i o lion the application. Incomplete applications will not be accepted.
Application T Date �p 22 • i!B
For oFice use only
jdosb Site Address (required) Vaiue of ConstruLtion (labor, materials, profit)
14 4 V1
Prooery Owner Name Address City/State Zip Phone
mirumoni NpQgimenfs 4900 'E'Rnr.=Vc po S-)B ma ?-n ugyo l
I Applicant Name Address ciylstaie Zip Phone
Contractor
ri ' Address y City/State Zip Phone
®, q Phone @
i Contractor City of Ft. CZMins Sales Tax Mpm ES Are you paying taxes here or by report? ❑ Here ❑ Report
sale tax number tareaured by all conbacol . Are you paying with your trust account? 'Yes ❑ No'
102-19 ".
s this a residential or commercial project? Residential ❑ Commercial
If residential, is it: ❑ Single Family Detached ❑ Condo/townhome (single family attached) Q Duplex
Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar Cl Church ❑-yotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this bullding 5v dears a-i age or more? ❑ Yes ❑ No if yes, you may need to contact Histoncpreservation
it this is for a dernoiitlosm per —mil, what year was the building constructed?
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j Description of work %z
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111" lawn sprinkler/bacic`low preventer, must list licensed my
_f T1-true AIC; rsusc list: licensed eieci—aacjari.
C._i?car sac ers: Ust the comoanyname orGty of Fr Collins license T
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Elettridan Plumber Mechanical Roofer Other
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? hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply witn all requirements contained herein and city ordinances and sate laws regulating building construction. 3 know that a
ipermit is not valid unfit it Fas been paid and- issued.
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�riritda7e: Signature Oaie
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