HomeMy WebLinkAbout5345 Country Squire - Permits/Addition or Alteration - 08/17/20059hCommunity Planning & Environmental Services
Building & Inspections Division
P.O. Box 580 281 N. College Ave.
Fort Collins, CO 80522-0580
City of Fort Coffins phone (970) 221-6760 Fax (970) 224-6134
JOB SITE ADDRESS 5345 COUNTRY SQUIRE WAY
PERMIT TYPE PER
MIN-ALT Minor Residential Alteration
Last Name, First, Middle Initial
RACHID, ALAELDIN
w Address City/State
5345 COUNTRY SQUIRE WAY FORT COLLINS, C
O Zip Phone No.
80528 204-4558
BUILDING PERMIT
Building Valuation
B0504597 ACCOUNT
PERMIT DATE
cj)8/ s i /d`/_'OU) Builu"ing h.nTit wl Subs
.EVEL CATEGORY TYPE
ISSU_FUL Residential Remodel City Sales/Use Tax
Construction Type Occupancy Group
County 5aies/Use Taz
wp No. of Stories Building Height
OBuilding Square Footage Stock Plan/Options
FEE I DATE PAID I
$51.98 81117/05
$45.00 8/17/05
$12.00 81/17/01
Z
Right Side Setback Left
Side Setback
• • • •
Z
Plat File No.
ZBA Case Number
Zoning District
(See reverse side for Inspection Description)
19
R M u I.
J
Subdivision/PLID
Filing
` N f B `4 f
Lot
19
Block
Lot Area
13 0
Parcel No.
8605465019
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icNp �NM �' '
ilfl
u G P i is f
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Company Name
Contractor License No.
Address
City/State
u
Supervisor Cert. No.
OPhone
V
-
Electrical
License No.
w
Mechanical
License No.
C
Roofing
License No.
Framing
0
License No.
m
Plumbing
License No.
v7
Concrete
License No.
Ili bL E '�iyt F? Air` 0"f'R SEP ABATE PERlv11TvU`A i 'UN, DRYWALL. GAS FIREPLACE TO BE
HOMEOWNER AFFIDAVIT ON FILE
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As a condition for the issuance of a permit, I hereby declare that I am an owner or the owner's agent, authorized to perform the proposed work on the property
described herein. I agree to comply with all City ordinances, and State laws associated with such work. I understand that such permit may be revoked in the
event that issuance was based on incorrect or incomplete information. This permit shall become null and void if the work authorized by such permit is not
commenced, suspended, abandoned or inspected within 180 days from the date of such permit or from the date of the last inspection.
61c ,e tal l'!, lec J i� d og — 0 —o[ o s— > 08.s Print name of owner/agent Signature Date TOTAL FEES