HomeMy WebLinkAbout4900 BOARDWALK DR - APPLICATIONS - 1/16/2017Jan 23 1701:21a Ellmann Service Co
9702233324 p.2
C
oor
f Collins
Planning, Development & Transportation •
281 N. College Ave . - P.O. Box 580
Fort Collins, CO 8D524
Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). 0 Air Conditiordng
❑ Demolfdon (interior nor -structural) ❑ Bectrical Alteration (not service change) ❑ Gas Lighter .0 Gas Log
D Heating Unit 0 Lawn Sprml her ❑ Mobile Home replaosment ❑ Roofing ❑ Sewer Line 0 Photo -voltaic
0 Ventilationlater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make. model and
manufacti.lrer). "
Complete all appl ble Information on the application. Incomplete applications will not be accepted.
Application #qff Date �I/� 017
rar affC&weorw
Sob Site Address (Mulmd) Value of Construction (labor, materials, profit)
XAM 1z.T'DCl raLaa 4- lb -Z04 $ sco - 2-q
Address �3
Guy/state Vtr• Zip
PhonR7 v
�(tjr o "I31y
(rJ C =-
371 —491?V
Appticant Name
Address
Gty/State Zip
Phone
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_ G , Sao -�-33� i
Contr-"r Lic *
Address
City/State Zip
Phone
Contractor My of Ft Collins Sales Tax 3ka{c; -- Are you paying taxes here or by report? ❑ Here O(Report
Salo taznumderisWU*Wbya#cnnesalws Are you paying with your trust account? 'Yes
❑ No
Is this a residential or commercial project? WResldentlal ❑Commercial.
if residential, is�ltSingle Family Detached 0 CondopMwnhome (single famriy attadied) . 0 Duplex
0 Mu[tlfandly (apartment) ❑ Garage 1.
Ifam mercial, is it O Bank 0 Bar ❑ Church 0 HoteVMotel O Medial office 0 Office O Retail
13 Restaurant ❑ other (explain)
is this building 5o years of age or more? i7 Yes 0 No Ifyles, you mayneed m ctmbctNlslnrrt Presiary &V
If this Is for a demolition permit; what year was the buitding constructed?
Ypdar m 197.5, you rfl need an asbesir+s assessment in suAv* tMCr this applicatba
*If lawn sprinkler/badvlow preventer, must list licensed plumber. If first -lime A/G must M licernmd electridan.
Subcontrj .
EIeL$idan Plumber N ewar*ml Roofer
Other
I herby admowiedge that I have read this appli®don and state that the above information is complete and correct I agree to
comply with ail requirements contained herein and city ordinances and state laws regulating building construction. I ]crow that a
Permit is not valid until it has been paid and is.
AppU4
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