HomeMy WebLinkAbout2026 Outrigger Way - Applications - 02/02/2004City of Fort Collins
BUILDING PERwrs & INSPECTIONS DMSION
P.O. Box 580 • Fort Collins, CO 80522.0580 • Phone: 221-6760 • Fax 221-6134
BUILDING PERMIT APPLICATION
Last First
Middle Phone
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Street Address Please Specify; LN. DR. CR. WY PL. ST CT RD. AVE.
City State Zip Code
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Company Name
License Number
Supervisor & Cert. #
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Mailing Address City
State Zip Code
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Phone
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Please Specify:
LN. DR. CR.
WY. PL. ST CT. RD. AVE. Zip Code
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Subdivision/PUD
Filing Number Lot
Block
Lot Area
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Building Square Footage
Number of Stories
Building Height
Number of Dwelling Units
Number of Bedrooms/Bathrooms Unfinish inished Basement Sq.-Ft
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Stock Plan Number/Options
Rad1
Energy Score/E-Star/Air Sealing/Blower Door
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Y / N
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Water Tap Size
Y Sewer Tap Size
Metered
3/y
Ty a of Heat:
Ele tric Main Breaker
61150
Size (Residential Only)
Temporary Electric Pedestal Requested:
Gas ❑ Electric
amp
or less 11200 amp ❑ other
XYes ❑ No
tthl�ll �► M (including labor, material, profit) $ i --, 8 2 3 c--
Description of Work:
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Job Contact Name & Phone #:
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Subcontractor Names:
Electrical 5 J Ee__E_ <L--r L Mechanical P-f r- P CLO c) �'� S Plumbing P � T V%-( C-' C--
Framer D 2 rL FCn vn I "' C, Roofing CP--orPf3ELL- P3-c-r:k--rzr-;� Concrete `,' r-'N
I 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 city ordinances and state laws regulating building construction.
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oSignature
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Print Name i '� O Phone 3 n 3 Z 3 r 13 3
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Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE