HomeMy WebLinkAbout1640 Independence Rd - Applications/Deck - 01/09/2004AMy
BUILDING PERN11TS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
City of Fort Collins BUILDING PERMIT APPLICATION
Last First Middle Phone
CD ; 1 At
c Street Address `ease Specify: Ity LN. DR. CR. WY PL. ST. CT RD. AVE. State Zip Code
Company Name License Number Supervisor & Cert. #
L
0
t5
L
Mailing Address City
State Zip Code
C
O
Phone
Please Specify: LN. DR. CR. WY. PL. ST. CT RD. AVE. Zip Code
JOB SITE ADDRESS I &,
Subdivision/PUD
R
o+
Filing Number Lot
Black Lot Area
Building Square Footage Number of Stories Building Height
0
0
Number of Bedrooms/Bathrooms Finished
Basement Square Footage
0
c�
Value of Construction (including labor, material, profit) $
r
Description of Work: �c-,(Z- 4tT- AA14
r5- X � d�
Subcontractors:
Electrical Mechanical
Plumbing
Roofing Concrete
Framer
A
4 C
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 and pity ordinances and state laws regulating building construction.
�It _ _
Signature
Print Name J.-, A &' ) /,-.—
Phone 2 Z 1` Z g q
Distribution: Original — L & P Yellow — Office
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE