HomeMy WebLinkAbout1040 Centre Ave - Permits/Backflow - 10/19/1987`f
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1
I*
ty of Fort Collins BUILDING INSPECTION DIVISION
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only.
Press firmly using ball point pen.
Job Address IVL�c G-o-,+re Aje
Name S I i?
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c
Mail Address
0
3fJ Ca�
612 hone ZZ/p- 15170
Name yl ' - 5 �,- Sn
o
Address Po CIf 4P
U
License No.
Phone
Contractor Sales Tax No. 7
42
Lot
Block
Filing Number
u
d
Subdivision 12&44-vE
r40V
cl
PUD - T- Olo '
;
Parcel #
DESCRIPTION OF WORK
S.rv- av, 5 �u«u�r7
�6/tt
Stock Options
No. --Codes
1Plan
Est. Total Cost 7
(including labor, material, profit)
I hereby acknowledge that I have read this application and
state that the above is correct and agree to comply with all city
ordman s and state lawsreg'ula/t�ing building construction.
signed date
— CLASS OF WORK —
New -Alteration Addition Demolish Move
❑ ❑ ❑ ❑ ,❑
Plbg. Mach. Elec. Struct. Fire Prot.
❑ ❑ ❑ ❑ ❑
Occ. Gr. Type Const.
Use Zone
Use of Building
Height
Lot Area
Frontage
Occ. Change from
=No.No.
.
No. D.U.a
Fin. Bsmt, areallo.
Fireplaces or stoves
— RELEASES — Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation FEES
Plan Check
Permit
0
Parkland
City Sales Tax
E2CEs'h1 t
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
-
Total Fees
Off -Street Parking
_ (No. Cars)
Interior Lot Cl
Corner Lot ❑
Reversed Corner Lot ❑
ro
r
ro`
d
m
1
m
y
ro
N
0
PRMTS 98.50
TOTL
Street CHCY.
N94351 18:03 A
OCT.PO'87
C
O
a
ZBA Case # Date
BBA Case # Date
Building Insp. Approval
by
date
279a r
toli
Permit No.
Date
Distribution: Original - Applicant; Blue - Office: canary - Sales Tac:.Plnk - ApPgianC Tag - Bldg. lnsp