HomeMy WebLinkAbout2567 S Shields St - Applications - 06/10/2002City of Fort Collins
BUILDING PERMM & INSPECI'IONs DmsION
P.O. Box 580 • Fort Collins, CO 80522-05M • Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
Last First Middle
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c Street Address Please Specify: LN. DR. CR. WY. PL.dV CT. RD. AVE. City
25 6�7 S-�5'l I'c- %a�'
R Mailing Addres
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Please Specify: LN. DR. CR. WY. PL. ST. CT. RD. AVE.E,/E
CM
Filing N
Building Square
Footage
Number of Dwelling Unit
L
y
Cj Stock Plan Number/Optio
coWater Tap Size
2i
Type of Heat:
❑ Gas ❑ Electric
Description of Work:��
e-,4e /-
Number of Stories
Number of
Energy
Y/N
Phone �p
Zip Code
tip uooe
Zip Code
Building Height
Electric Main Breaker Size (Residential Only) Temporary Electric Pedestal Requested:
❑ 150 amp or less ❑ 200 amp ❑ other 1 ❑ Yes ❑ No
(including labor, material, profit) $ q106
Job Contact Name & Phone #: /
Subcontractor Names:
Electrical 4h n"! Mechanical Plumbing P4 IV
v h eft �/ h > 4
Framer P Roofing N Concrete %r
I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all
requirements contained herein and city ordiinan�ce nd state laws regulating building construction.
'o. Signature
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Print Name , Phonec��
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE
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