HomeMy WebLinkAbout1424 Independence Rd - Permits/Electrical - 12/17/1986City of Fort Collins BUILDING INSPECTION DIVISION
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only.
.ti Press firmly using ball point pen.
Job Address
Name fe,H/- r
d
c
Mail Address Z —
- -
3
O
Phone
Name M o E
0
Address ao ' E (e
c
0
U
License No
Phone oil. _O 7 7
C
Lot
Block
Filing Number
N
Subdivision
PUD
is
Parcel #
DESCRIPTION OF WORK
Stock , _ 37 Options
Plan No. Codes
Est. Est. Total Cost qngL0
(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
ordinances hand state laws regul ng building construction.
AX-� he-
date
— CLA§iS OF WORK —
New Alteratio
❑
Addition Demolish
❑ ❑
Move
❑
Plbg. Mach.
❑ ❑
Elec. Struct.
❑ ❑
Fire Prot.
❑
Occ. Gr. Type Const.
Use Zone
Use of Building
Floor Area
No. Stories
ofWra!Sj
Fr tage
Occ. load/Oc
nge fr
Plat Fillo.
N r
Garage area
m a
Type heat
No. Fireplaces or stoves
— RELEASES —
Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
5 a
Valuation
FEES
Plan Check
Permit
Parkland
City Sales Tax
St. Oversizing
Water Plant Investment
-
Sewer Plant Investment
Storm Drainage
Electric Underground
Total Fees
Off -Street Parking
(No. Cars)
Interior Lot
❑
Corner Lot
❑
Reversed Corner Lot
❑
_'A
Ni
to
ir
m
n
M
rn
c
0
Ji
Street
N95487 1217".
4
o
ZICc.i7'i6
E
ZBA Case#
Date
BBA Case If
Date
Building Insp.
Approval
by
date
..
— / 0
Permit No.
Date
,ay
Dislribufion: Original - Applicant, Slue - Office; Canary - Sales Taff, Pink - Applicant: Tag - 81dg. Insp.