HomeMy WebLinkAbout4726 Dusty Sage Loop - Applications - 11/07/2003City of Fort Collins
BUILDING PERMITS & 1NSFECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
WS aft Date
L First Middle
CD Address Ple se Specify: LN. DR. CR. WY PL. ST CT. RD. AVE. City
1 ��? *3-
ny Name License Number
Mailing Address/ / City State_
hone
Please Specify: b
Subdivi io /PUD
�, v �� 126:
Filing Number Lot.
Building Square Footage 7
0
Number of Dwelling Units
VJ
Stock Plan Number/Options
N Water Tap Size 3/
67
Type o at:
❑ Gas ❑ Electric
Description of Work:
LN. DR. CR. WY PL
Block Lo
Number of Stories
Rad
y4
Sewer
Electric n Breaker Size (Residential Only)
50 amp or less ❑ 200 amp ❑ other
(including labor, material, profit) $
i�
;rvisor & Cert. #
CT. RD. AVE. Zip
4� 0,e5p
y237-
Building Heigh
y-H ctric Pedestal Req
s ❑ No
Job Contact Name &Phone #: �z Z � ; r1:5 Z
Subcontractor Names: 7
Electrical ��(—��.r Mechanical qp ric_ �F� r -5 Plumbing ��d�o
�"a,
Framer Roofing RoofingConcrete
lowed r Door v
I hereby acknowledge that I have r th' cation state that the above information is correct and agree to comply with all
requirements containe herei state -laws regulating building construction.
R
'o. Signature
o.
Print Name Phone e:� Z
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE