HomeMy WebLinkAbout439 Peyton Dr - Applications - 09/09/2003BUILDING PERMITS & INSFECYiONS DIVISION
PO. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
P
Last
First
Middle
Phone
GStreet
Address Please Specify: LN. DR. CR. WY. PL. ST. CT. RD. AVE.
City
State Zip Code
Il o 61 r
an A
5
e r— dMa-O
Co any Name
License Number
Supervisor & Cert. #
Mailing Address
City
State
Zip Code
C
Phone
Please Specify: LN. DR. CR.
WY. PL.
ST. CT. RD. AVE. Zip Code
24
Subdivision/PUD
Filing Number
Lot I Block
Lot Area
Building Squaare Footage
1_7
Number of Stories
a� t t t Buildin He t
Number of Dwelling Units
Number of Bedroo /Bathrooms
nfinis ed fished Basement Sq. Ft.
Stock Plan Nu be�l0 tions
Rado
Ener Score/E-Star/Air Sealing/Blower Door
i�
Y / N
V
Water Tap Size
Sewer Tap Size
Metered
H
3 u `t
Ty a of Heat:
EI ctr'c Main Breaker Size (Residential Only)
Te
p ary Electric Pedestal Requested:
Gas ❑ Electric
150 amp or less ❑ 200 amp ❑ other
Yes ❑ No
1 1 1
(including labor, material, profit) $
jLj It
4-71,
2-Qb
Description of Work:
Mkrhl�UeV
Job Contact Name & Phone #:
on
Subcontractor Names:
Electrical KA N )EA'Q y� 0 Mechanical �k6w kQ '1T Plumbing I(,(1 16 \
Framer j LLT;Oatrn Roofing Concrete h 7U ItiC�OtI
.. ,.aa.�.t..
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 an city ordinances and state laws regulating building construction.
A
o Signature
CL
a Print Name r Phone 3t�3 4GG /83/
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE