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HomeMy WebLinkAbout5115 Fruited Plains Ln - Applications - 12/29/20037 TO BUILDING PERMITS & INSPECTIONS DIVISION P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 224-6134 BUILDING PERMIT APPLICATION L La First Middle Phone G�,O C� c Street Address Please Specify: LN. CR. WY. PL. ST. CT RD. AVE. City State Zip Code tmtoi S� VVI I I V , c;13Q r e 66) r� Co any Na e Iric�,r►�se Number Supervisa& Cert # cMailing Address • I City (�� �� ��1 E ( Zip C e / /I P one S/4 ( `LU3� N `i" v0 1 : Pleasee�� pecrciffy: N DR. CR. WY. PL. ST CT. RD. AVE. (' Zip Code 1 1 ' '15 1 ✓- rkI* -ph J c� UAL R Subdivisi n/PUD � � � Filing Number of Block Lot Area 15(a0 Building SI u�re Footage Number of 8to ries Building Height c �a 0r TIA Number of Dwelling Units Number of B drooms/Bathrooms LJnfinisheqtFinished Basement Sq. Ft. H C 0. 5-7© 0 Stock Plan Number/Options Radon Energy Score to /City Prescriptive 1165 Y / H a) Water Tap Size Sewer Tap Size Mete d l�� 4 / a J Type of Heat: Electric Main Breaker Size (Residential Only) TX150 Temporary Electric Pedestal Requested: A -Gas ❑ Electric amp or less ❑ 200 amp ❑ other Yes ❑ No 1 1 1 (including labor, material, profit) $ In & 10 l 6 p Description of Work: Job Contact Name & Phone #: �(XV-t Ke UAA q70 oQ 3 ` / 9 63 Subcontractor Names: (D Electrical O-An �IN — Mechanical � � Plumbing Framer K,4-,- L— Roofing 1 R C.i .Q o. a niviv ram 4un10m auuunuary uesrgnanon signature DBtQ TM I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all requirements coan ned herein and city ordinances and state laws regulating building construction. Signature Print Name t�lG.-Igfa ci ��� Phone 2- Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater