HomeMy WebLinkAbout1209 Town Center Dr - Permits/Sprinkler - 08/18/2006Community Planning &Environmental Services BUILDING P E RM I TPERMIT FEES
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
ACCOUNT FEE DATE PAID
JOBSITE ADDRESS PERMIT DATE
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PERMIT TYPE PERMIT LEVELResidential SpriAklar System IP!j CATEGORY TYPE 8u i Wag Perm it w, o dub $15 , u 8 / 18 / 0
Last Name, First, id a nitial 1 City Sales/Ilse Tax $ 2 , 5 8 / 18 / v
onSfPuction ype Occupancy Group
w County Sales/Use Tax $0. 0 8/18/0
Addres City/State C) No. of Stories Building Height
0 Zip Phone No. FORT 00661NS, GO U Building Square Footage I Stock Plan/Options
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Right Side Setback
Left Side Setback
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Plat File No.
ZBA Case Number Zoning District
Subdivision/PUD
Filing
Q
WLot
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Block
Lot Area
Parcel No.
Company Name Contractor License No
Phone
tlectrical
License No.
W
Mechanical
License No.
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URoofing
License No.
Framing
License No.
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Plumbing
License No.
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Concre u r e
License No.
MDT PLUMBING TO INSTALL BACKFLOW FOR SPRINKLERS
� I PROVIDE REQUIRED BACKFLOW PREVENTER TEST RESULTS
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(See reverse side for Inspection Description)
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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.
Print name of owner/agent Si ture Date TOTAL FEES