HomeMy WebLinkAbout913 Breakwater Dr - Applications/Building Inspection - 04/18/1985b
CITY OF FORT COLLINS
P.O- Box
Fort Collins.s. CO 80522 NOTICE OF BUILDING PERMIT APPLICATION
Building Address
(3 kE -r e I�t
PROPERTY
Subdivision or P.U.D. Filing No.
Lot No. Block No.
LEGAL
DESCRIPTION
% E (A/VT) NC-S
/� -
Lot Area
Corner Lot:
Total Street Frontage (lineal feet)
I -it 8�y l/1
7
Yes No
Name
Phone
& RS OLUIVEA.
CONTRACTOR
Address City State Zip Code
Name
Phone
Okla axe ('04000.
OWNER
uCE E I H
-0?14
Address City State Zip Code
STORM 809.75
90s U/ 6-N G L )EL ON> 0_ 03TL 809.7&psi
- t,r LK ry ,
Single Family Commercial ❑ qinr8ZgRof1UnlO. A
USE OF
MAY.10'85
BUILDING
Multi -Family El Other:
TYPE
OF HEAT
Gas � Electric ❑ Heat Pump ❑ Baseboard ❑ Radiant ❑ Other:
WATER AND
�p
Metered Flat Rate❑
SEWER
Water Tap Size:�
Sewer Tap Size:
Drainage Basin -
Gross Area '704-1
STORMWATER
g se Rate
Runoff Coefficient
Detention Reduction Factor
Fioodplai
UTILITY
(J
4-1 j r
{
I
Yes No
(To be
completed
U 'lity Fund Nutriber
t {jr�
Storm Drainage Basin Fee
by others)
��,s'�}-�t
Stormwat r Utility Sign ture
NOTE:
I understand that the Storm Drainage Basin Fee must be paid prior to the issuance of a Cer-
tificate of Occupancy. I further understand that if drainage improvements are required for
this site, two (2) copies of a drainage report and a drainage plan, signed and stamped by a
APPLICANT
Colorado -registered Professional Engineer, must be submitted to the Stormwater Utility for
approval before a Certificat Occupancy will be issued.
Signature of Applicant:
_
Date:
DISTRIBUTION t. Original: Applicant — 2. White: Building Inspection — 3. Gold: Stormwater Utility — 4. Blue: Transportation Utility
— 5. Pink: Light & Power — 6. Yellow: Water & Sewer I