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HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 12/6/2016Dec 29 16 08:07p Ellmann Service Cc 9702233324 PA C Planntng, Development & 7Yansportait en City crf 281 N. College Ave. -P.O. Box 580 ��rt Colhn5 Fort Collins, CO 80524 r' - �- Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMITS ONLY This application la to be used to apply for tho following permits only (check all that apply). 0 Air Conditioning O Demolition (interior non-structural) ❑ electrical Alteration (not service change) ❑ Gas Lighter O Gas Log O Heating Unit O Lawn Sprinkler 0, Mobile Home replacement ❑ Roofing ❑ Sewer Line O Photo -voltaic O Ventdatior later Heater 13 Water Line 0 Wood/Pellet Stove (must be EPA certified, provide make, model.and manufacturer). Complete all appi II Inrfo�r-maatio�nlon the application. Incomplete applications/will /not be accepted. Application #_ �` QU ` I`1 L Date For afte rese onty Sob Site Address (regaled) Value of Construction (labor, materials, prof)) a Address l355 . City/state Ver MP Phony( 1 o air o "1 Y I � - � 2z2 371. -49i7o Applicant Name Address City/5tate Zip Phone �'•j�t�: ?i G f'^�Gn�.r,� .c: '7�=` Cif+��G� Zi - G d�( 52a -:fit`-ni L Contractor Lic # Address City/Smte Zip Phone Contractor City of FL Collins Sales Tax # Are you paying taxes here or by report? O Here frrReport -Wes wxnwnberrsragr hWbYaaWnftVdars Are you paying with your trust account? [?'Yes 0 No Is this a residential or eommercal pMect? 07Residential 0 Commerdal If residential, is .it {Single Family Detached ❑ Condo/townhonie (Single family attached) 0 Duplex 13 Multifamlly (apartment) © Garage ifcammeraai, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medici office O Office 0 Retail ❑ Restaurant ❑ Other (explain) Is this building 50 years of age or more? 0 Yes ❑ No ffyes, you mayneed to cvatactHmadcT:i, vabbn If this is for a demoiltion permit, what year was the building constructed? Ifprior lb 1975, yvu w1t1 need an astaesMs assessment Pn submit with ttitsappGralion. Description ofY *If lawn sprinider/baddlaw yreventar, must list licensed plumber. If first-time A/C, must lia licensed alectriaan. �subeontraciors UsrohecompaeynameorGtyaffredAWA:ense0 Etecrl9dan Ptvmbe� Mechanical Roofer t]tl�r I hereby acimowledge that I have read this application and state that the above Information is Complete and Correct I ape to comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a permit is not Vaud unm it has been paid and Issued. Appticaft print Warne: ;W46w S 46 1. e. Sig -- pate