HomeMy WebLinkAbout1724 Brookhaven Cir E - Special Inspections/Concealed Construction - 08/10/2004Comrmlanity Plara-Lin ; and Envii,o:nraerital Services,
Buildino and "oning L.aepartment
PERMIT AND INSPECTION REQUEST FOR
EXISTING NON-STRUCTURAL CONSTRUCTION
Please print or type
Address: 17Q_ E,t2ooita�u��,b�
Date: I Id I gzDo
IIWE G r�o� ���121� y as owner(s) of
record of the above property, hereby request a pern-Ji for and final inspection of the
installation or construction work described in the following building permit
application, which work was completed or covered without obtaining a permit and
without required inspections during construction. I/we understand and agree that
the City of Fort Collins Building & Zoning Department will perform a final inspection to
assess compliance of such work, some or all of which may be concealed by
permanent construction and finish materials, based on observable conditions and
nondestructive methods: and, that it may not be practical or possible for the City of
Fort Collins to verify full compliance with City building codes without removal of such
permanent construction and finish materials. I/we further understand that any
violations of City Codes related to health and safety associated with the above work
or installation may require correction.
Work performed by: Un ��'l4cc� n
Name Address
Date work performed: p 4,L _?00 3
(Signatur Date g o A _
(Signature)
For office use only:
Pem-)it/Application Number
Date applied:
Date
80405157
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