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City of Fort Collins
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BUILDING PERMITS & INSFECPIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
BUILDING PERMIT APPLICATION
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LN. CR. WY. ) ST. CT. RD. AVE. City State
License Numbe Supervisor & Cert. #
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Please Specify. LN. D CR. WY. PL. ST. CT RD. AVE.
JOB SITE ADDRESS
Company Name
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Filing Number L Lot Block Lot Area
Building Square Footage Number of Stories
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Value of Construction (including labor, material, profit) $ s2, 7A 5
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Subcontractors:
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Roofing Concrete ramer
1 hereby acknowled that I aver h' application and state that the above information is correct and agree to comply with all
requirements con Ined h ein tl ci , dinances and state laws regulating building construction.
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Distribution: Original — L'& P Yellow — Office
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE