HomeMy WebLinkAbout1202 Nassau Way - Applications - 10/02/2003City of Fort Collins
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BUILDING PERmTrs & INSPECTIONS DMSION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 2M-61M
BUILDING PERMIT APPLICATION
Last First /f Middle
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Phone
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Street Address Please pecify: LN. DR. CR. WY. PL. ST. CT RD. AVE. City
State
Zip Code
Company Name License Number
Supervisor & Cert. #
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Mailing Add ess City State
Zip Code
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Phone
jr1e;eSpecify: LN. DR. CR. L.
ST CT RD. AVE.
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Subdivision__//PUD
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Filing Number
Lot Block Lot
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Building Square Fo
tage Number of Stories
ilding Height
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Number of Dwelling nits Number of Bedrooms/Bathroo
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inished Basement Sq. Ft.
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Stock Plan Number/Options Rad
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Metered
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Type of Heat:
Electric Main Breaker Size (Residential Only)
Temporgry Electric Pedestal Requested:
Gas ❑ Electric
&/150 amp or less ❑ 200 amp ❑ other
Li Yes ❑ No
(including labor, material, profit) $ /qg
Description of Work:
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Job C tact Name & Phone #:
ll9,y G�asrne�---59�-0971 arL /an�j 4)&24_ar 3e93-5ql-Dq, 9
Subcontractor Names:
Electrical /✓&d /,do,-ld Mechanical Alan .rg 61ola4 I/r Plumbing A`�P.�1
Framer h"=p }y 750ofing 9014R�lConcrete AIW
I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all
requirements con, ' ed herein and city ordinances and state laws regulating building construction.
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.a Signature
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Print Name v Phone - .5``? / - O9 7
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE