HomeMy WebLinkAbout1309 Catalpa Dr - Applications - 06/30/2004BUILDING PERMITS & INSPECTIONS DMSION
P.O. Box 580 • Fort Coffins, CO 80522-WSO • Phone: 221-6760 • Fax 224-6134
www.fcgovcom
BUILDING PERMIT APPLICATION
Last
First Middle
Phone
ID
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Street Address Please Specify: LN. DR. CR. WY. PL. ST. CT. RD. AVE. City
State Zip Code
3aQ Tip
/ ORVIEAl. 40uz-lyx
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Company Name
License Number
Supervisor & Cert. #
AW
Mailing Address
City State
Zip Code
o
.
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c2
Phone,
Please
Specify: LN. DR. CR. WY. PL, ST CT. RD. AVE. Zip Code
Subdivision/PUD
T A7�. L
Filing Number
Lo Block Lot Area
Building Square Footage
Number of Stories
Building Height
0
L
Number of Dwelling Units
Number of Bedrooms/Bathrooms
Unfinished/Finished Basement Sq. Ft.
w
Stock Plan Number/Options
Radon
Energy Score/E-Star/Air Sealing/Blower Door
Y/N
y
Water Tap Size
Sewer Tap Size
Metered
Type of Heat:
Electric Main Breaker Size (Residential Only)
Temporary Electric Pedestal Requested:
❑ Gas ❑ Electric
❑ 150 amp or less ❑ 200 amp ❑ other
❑ Yes ❑ No
l (including labor, material, profit) $ ,2. '
00CA 0C
Description
of Work:
.ion 4ontact Name &Phone #�hhly
Subcontractor Names: ! v 7
Electrical Mechanical Plumbing
Framer
R
2
.Q
a.
a
Roofing
Concrete
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.
Signature
Print Name Phone ,:367.31'
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE