HomeMy WebLinkAbout821 Province Rd - Applications - 07/07/2004BUILDING PERNIIn & INSPECTIONS Dmsm
P.O. Box 580 • Fort Collins, CO 8052M580 • Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
Last First
Middle Phone
CD
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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. #
0
Mailing Address City
State Zip Code
cm
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Phone
Please ecify: LN. OR,
CR, WY PL, ST CT RD, AVE. Zip Code
R
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C,
IN
Filing Number L 6 Blo k
Lot rea
o
Building Square F otage Number of ries
ildi�g Heig t
Dsh
Number of Dwelling Units Number of Bedr ms/Bathrooms n i Finished Basement Sq. Ft.
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Stockplm Wtions Radon
N//�
EnergyScore/E-Star/Air Sealing/
Y /
Water Tap Size J/ytf Sewer T rSp
Metered
Type of Heat:/
Gas ❑ Electric
Electric Main Breaker Size (Residential Only)
�50 amp or less ❑ 200 ❑
Temporary Electric Pedestal Requested:
amp
other
;CYes ❑ No
t7I:111 all a 1 11�11tllMnu►■ (including labor, material, profit) $ , -� -z`,, 3 . �
Description of Work:
Job Contact Name & Phone #:
Subcontractormptdl
AeA�Electrical Mechanical Alp— Ppa; L Plumbing 2 T
Framer Roofing PfMPOED— 9CA-RS Concrete b� y
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 an ity ordin d st laws regulating building construction.
R
w—.
CL
a Signature
Print Name
A Phone
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE