HomeMy WebLinkAbout614 Keenesburg Ct - Applications/Single Family New - 08/25/2003City of Fort Collins
BUILDING PERNIITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
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First
Middle hone
CD
CD
lly,�83
45-45(40 �
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03
Street Address Please Specify: LN. DR.
CR. WY PL. ST CT. RD. AVE
City State Zip Code
1
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Company Name
License Number
Supervisor & Cert. #
CD
R
Mailing Address
City
State Zip Code
C,
C,
Phone
Please Specify:
LN. DR. CR.
WY PL. ST. CT. RD. AVE. Zip Code
Subdivision/PU
Ca
°;
Filing Number Lot
Block
Lot Area
Building Square Footage
Number of Stor' s
Building Height
ts
L
Number of Dwelling Units
Number of Bedrooms/Bathrooms Unfinished/ he�sement Sq. Ft.
VJ
Stock Plan Number/Options,
Rad
Energy Score -Star/Air Seal' g/Blower Door
�. L .
Y N
WaterTap Size
Sewer Tap Size
Metered
Type of Heat:
Elect 'c Main Breaker Size (Residential Only)
Tempo ary Electric Pedestal Requested:
Gas ❑ Electric
X 150 amp or less ❑ 200 amp ❑ other
Yes ❑ No
VALUE OF CONSTRUCTION WIMI ►��,T�liif��-
Job Contact Name & Phone #:
Print Name (�pr �� h9ay?/ Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE