HomeMy WebLinkAbout2209 W Lake St - Permits - 01/09/2004Community Planning &Environmental Services BUILDING P E RM I TPERMIT
FEES
Building & Inspections Division
P.O. Box 580 281 N. College Ave.
Building valuation
Fort Collins, CO 80522-0580
City of Fort Collins phone (970) 221-6760 Fax (970) 224-6134 B 0 4 0 0 11
ACCOUNT
FEE
DATE PAID
JOB
SITE ADDRESS
PERMIT DATE
2009 W LAKE ST
C) ' 0 9 `2 ;>vq
8r;1Idi ay rlermilt w/o Subs
a 15. C
1119/ 04
PERMIT
TYPE
PERMIT LEVEL
CATEGORY TYPE
j
MECH Mechanical Alteration
ISSU FUL
Residential
Last Name, First, Middle Initial
Construction Type
Occupancy Group
tie
MILLER LON
Address
City/State
Wp No. of Stories
Building Height
UJI Z
3
PO BOX 2473
FORT COLLINS CO
Zip
Phone No.
V Building Square Footage Stock Plan/Options
O
80522
227--0322
Front Setback
Rear Setback
0
_Z
Right Side Setback
Left Side Setback
• • •
Z
N
Plat File No. ZBA Case Number
Subdivision/PLID
Zoning District
Filing
(See reverse side for Inspection Description)
G L f II M
J
wLot
Block Lot Area Parcel No.
J
o 9115306089
Name Contractor License IN
OCompany
V
Address City/State
H
Z
O
Pnone Supervisor Cert. No.
Electrical License No.
CX
Mechanical
License No.
11nT Atli l CHFAIING A AIR
on
Roofing
License No.
H
Framing
License No.
Z
V
m
Plumbing
License No.
h
Concrete
License No.
INSTALL FURNACE
As
a condition for the issuance of a permit, I hereby declare that I am an owner or the owner's agent, authorized to perform the proposed work on the property
described
herein. I agree to comply with all City ordinances, and State laws associated with such work. I understand that such permit may be revoked in the
event
that issuance was based on incorrect or incomplete information. This permit shall become null and void if the work authorized by such permit is not
commenced,
suspended, abandoned or inspected within 180 days from the date of such permit or from the date of the last inspection.
name of owner/agent Signature Date
TOTAL FEES
$115.0lill
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