HomeMy WebLinkAbout610 S Loomis Ave - Applications - 04/02/2003E 4:
City of Fort Collins
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
BUILDING PERMIT APPLICATION
Last
First
Middle
Phone
r-� --z�
A y�,_
�o <
c
Street Address Please
Specify: LN. DR. CR. WY PL. ST. CT RD. AVE.
City State
Zip Code
�-z C) 6
IC7- (O t-- C, -�, -i C-.>
90
Company Name
License Number
Supervisor & Cert. #
0
Mailing Address
City
State
Zip Code
o
" I Phone
Please Specify: LN. DR. CR. WY. PL. ST CT RD. AVE. Zip Code
JOB SITE ADDRESS
Subdivision/PUD
a+
Filing Number Lot Block Lot Area
Building Square Footage Number of Stories Building Height
0
L
Number of Bedrooms/Bathrooms Finished Basement Square Footage
0
c�
Value of Construction (including labor, material, profit) $ �a C) 0 Q
Description of Work:
Subcontractors:
Electrical Mechanical Plumbing
Roofing Concrete Framer
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 herelp ity ordinances and state laws regulating building construction.
R
Q Signature
a
Print Name A-L- 7 ov- Phone e-/ p i = S(5 O S
�7
Distribution: Original — L & P Yellow — Office
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE