HomeMy WebLinkAbout7420 Matheson Dr - Applications - 05/26/2004E °fi
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City
of Fort Collins
BUILDING PERMTTs & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
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Last First
Middle Phone
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Street Address lease Specify: LN. DR. CR. WY PL.
ST CT. RD. AVE.
City State Zip Code
Company Name
License Number
Supervisor & Cert. #
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Mailing Address City
State Zip Code
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Phone
Please Specify:
LN. DR. CR.
WY. PL. ST. CT. RD. AVE. Zip Code
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Subdivision/PUD
CM
Filing Number Lot
Block
Lot Area
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Building Square Footage
Number of Stories
Building Height
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Number of Dwelling Units
Number of Bedrooms/Bathrooms Unfinished/Finished Basement Sq. Ft.
1 is
Stock Plan Number/Options
Radon
Energy Score/ E-Star/ Air Sealing/Blower Door
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Y / N
Water Tap Size
Sewer Tap Size
Metered
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3 4
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Type of Heat:
Electric Main Breaker Size (Residential Only)
Electric Pedestal Requested:
Gas ❑ Electric
6150 amp or less ❑ 200 amp ❑ otheYes
TTempo—rary
❑ No
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Job Contact Name & Phone #:
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Subcontractor Names: `j
Electrical Nf �\ Lecyc is Mechanical G + 6S6,-\ �Nec��f� Plumbing V�-._"kLj P jklmk,�0
Framer m L (-C).M 10o,� Roofing ;�� �(�er� �C(}�`; Concrete U � YGeJe 1U iCGn �
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 ci dinances and state laws regulating building construction.
a Signature
Print Name Phone 3a3 ¢GL - J�3i
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE