HomeMy WebLinkAbout2820 Annelise Way - Permits/Sprinkler - 10/12/2006Community Planning & Environmental Services BUILDING I LDI NG PERMITPERMIT
FEES
t� Building & Inspections Division
P.O. Box 580 281 N. College Ave.
Building Valuation
-
Fort Collins, CO 80522-0580
City of Fort Collins phone (970) 221-6760 Fax (970) 224-6134 806047' 8 7
ACCOUNT
FEE
DATE PAID
JOB
DDRESS
SITE ADDRESS
PERMIT DATE
1 /'�
�'
Building Permit W/o Subs
$15.
0 10/12/0
PERMITTYPE
PERMIT LEVEL
CATEGORY TYPE
SPKLR-R Residential Sprinkler System
City Sales/Use Tax
$3.
0 10/12/0
Last Name, First, Middle Initial
Construction Type
Occupancy Group
t
County Sales/Use Tax
a0.
0 10/12/0
Address
City/State
in No. of Stories
Building Height
O
O
zip Phone
No.
Building Square Footage
Stock Plan/Options
80014303-466-1381
Front Setback Rear
Setback
b
Z
Right Side Setback Left Side Setback
Z
• � •
Plat File No. ZBA Case Number zoning District
433
Subdivision/PUD Filing
(See reverse side for Inspection Description)
SPK
_
Q
wLot
Block Lot Area Parcel No.
J
43
Name Contractor License No.
OCompany
T
Address City/State
r
Z
0
Phone Supervisor Cent. No.
Electrical License No.
W
Mechanical
License No.
Roofing
License No.
H
OFraming
License No.
U
Plumbing
License No.
m
Concrete
License No.
SPRINKLER SYSTEM TO BE INSTALLED BY AUTUMN LANDSCAPING 3555 S SHERMAN ST 02,
ENGLEWOOD,CO 80113 303-794-6993 PROVIDE BACKFLOW DEVICE AND BACKFLOW TEST RESULTS TO BE
INSTALLED BY BACKFLOW TECH, 608 GARRISON ST #L, LAKEWOOD,CO 80215. 303-986-4601
As
a condition for the issuance of a permit, I hereby declare that I am an owner or the owner's agent, authorized to perform the proposed work on the property
described
herein. I agree to comply with all City ordinances, and State laws associated with such work. I understand that such permit may be revoked in the
event
that issuance was based on incorrect or incomplete information. This permit shall become null and void if the work authorized by such permit is not
commenced,
suspended, abandoned or inspected within 180 days from the date of such permit or from the date of the last inspection.
name of owner/agent Signature Date
TOTAL FEES
$18.
0
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