HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 12/4/2018Dec 04 18,08:22p ellmann service compony 970-482-0416 p.1
Planning, Develop>nimat & Transportatim
Citycif �.} , ����lns 261 N. CoOege Ave P.O. Box 580
F�I {
Fort Coffins, CO 8=4
Phone 970-416-2740 Fax 224.6134
OVEWTHE-COUNTER PERMITS ONLY
This app&cation Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) D Electrical Atteration (not service change) ❑ Comas lighter 0 Gas log
❑ HeaUng Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer tine ❑ Photo voltaic
❑ Ventilation ;2-Water Heater ❑ Water line 0 WoodlPellet Stove (must he EPA cerfified, provide make, model and
manufacturer).
Complete all applicable Infimnatlon on the application. incomplete applicadons will not be accepted.
Application # 0 1 CbI 0 5 `! `
Forofiae tw a*
Dane 11// Us
Job She Address (r�ewA09
value of Construction (labor, materials, profit)
�305 Zo 05
Owner r� �, r s 1355 Gty/State ViW,Prt Zip Ph
0 -I
V �zzz 3�r - Ana
Ap pTicant tamme Address
City/State Zip Pho
3312
Contractor 01mA71-1^1 !► Address
city/state zip
33 3
-c::5 cavic
Contractor City of Ft. Collins Sales Tax #-3a ZOa
Are you paying taxes here or by report? 0 Here ,' 41"Mrt
-gem tax nrxn wisfegI&WbyaAcavr&M:Ms
Are you paying with your trust account? AKYes ❑ No
Is this a residential or commercial project? XResidential ❑ Commercial
If residential, is it: 16-singie. Family Detached ❑ Condo/Oownhome (single family attached) Cl Duplex
❑ Multifamily (apartment) ❑ Garage j
if coninerciai, is Ib E3 Bank 0 Bar ❑ Church 0 Hotel/Motel ❑ Medical office 17 Office 17 Retail
❑ Restaurant 13 Other (explain)
Is this building 50 years of age or more? U Yes ❑ No rfyes,. you may need to canfmT H&& c PA%Vrvatfon
If this is for a demolition permit, what year was the building constructed?
I.
Ifpnor m 1975, you xW fnwd an asbestos assessment to submit with d* appAWtrhn.
Description of wort(
*If lawn sprinkkr/baddiow preventer, must list fib plumber. If first-time A/C, must list licensed electrician.
SubcoWftckoMlistbreCWZU WnameorC2yafRColJins&VW#
EIBcbfdBn Pltprrber = Med%antmi Roofer Other
I hereby acknowledge that I have read this apprhtation and state that the above information Is complete and correct.. I agree to
comply wtth all requirements contained herein and city ordinances and state laws regulating building construction. I tamer that a
permit is not valid unt8 it has been paid and Issued.
y!,Ic Ic1-