HomeMy WebLinkAbout4615 Dusty Sage Dr - Applications/Single Family New - 04/11/2005 (2)City of Fort Collins
BUILDING PERmrrs & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
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Street Address Please Specify: LN. DR.
CR. WY. PL. ST CT. RD. AVE. City
State Zip Code
any Name
License Nymber Supervisor & Cert. #
0
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Mailing Address
City State
Zip Code
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Phone
PleasSpecify:
LN. R. R. WY. PL. ST CT RD. AVE. Zip Code
1:
III'
& 1'�5
IAM4 45)-M It
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Subdivision/PUD lj,,
7 11
Filing Number
Lot 4
Block Lot Are
944 C-a9
/7
I - --C/
Building Square Footage
/ M
Number of Stories
Building Height
Number of Dwelling Units
Number of Be r athrooms
Unfinish d/ finished Basement Sq. Ft.
N
C,
Stock Plan Number/Options
Energy it Sealing/B ower Door
N
y
WaterTap Si �I9
Sewer Tap Size
Metered
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Type eat:
Electric
ain Breaker Size (Residential Only)
Tempor
lectric Pedestal Requested:
as ❑ Electric
0 amp or less ❑ 200 amp ❑ other
es ❑ No
1 1 1 (including labor, material, profit) $
Description of Work:
Job Contact Name &Phone #: MOL ZZZ 3
Subcontra Names:
Electrical Mechanical `. Plumbing —a .)W s w,Yb1C�
Framer OIQ,In,�l14J� Roofin�pp „J(� concrete AkAQ,>
I hereby acknowledge that I have
requirements contained in c
CR 0
-a Signature
Print Name
thi
ate that the above information is correct and agree to comply with all
laws regulating building construction.
Phone ��'7�
Distribution
White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE