HomeMy WebLinkAbout2644 S Timberline Rd - Applications/New Commercial - 02/02/2005City of Fort Collins
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
Last o o Cc First Middle
Phone
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Street Address Please Specify LN. DR. CR. WY PL. ST CT. RD. AVE. City
State Zip Code
66 � S
Company Name License Number Supervisor & Cert. #
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Mailing Address City State
Zip Code
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6
Phone
4TCJ-., A/
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Please Specify: LN. DR. CR. WY. PL. ST. CT
RD. AVE. Zip Code
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Subdivision/PUD
g z 7 i 7,u /t/k% of -7V87 a 90 00 0 a,P
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Filing N mber Lot Block Lot Area
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Building Square Footage Number of Stories
Building Height
s
lA/a O S i O�t/C� 6/ J
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Nu ber off Units Numb r of Bedrooms/BathroomsUnfinished/Finished
Basement Sq. t.
N
/Dwywelling
A1/F 02 �A7h2C90ryi
Stock Plan Number/Options Radon Energy Score/ E-Star/ Air Sealing/Blower Door
A1,4 Y / N
Watel-Tap Size Sewer Tap Size
Metered
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Type of Heat:
Electric Main Breaker Size (Residential Only)
Temporr
Electric Pedest I Requested:
❑Gas ❑Electric
❑ 150 amp or less ❑ 200 amp ❑other
C�'Yes
❑ No
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Description of Work:
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Job Contact Name & Phone #: _
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Subcontractor Names:
Electrical -176 P Mechanical 7-ITD Plumbing
Framer T,L D Roofing -�rBD Concrete 7;9)D
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.
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a Signature �0 c��5,dd
Print Name / �� �; 5.,�, / Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE