HomeMy WebLinkAbout214 Jackson Ave - Permits/Electrical - 10/04/2005Community Planning &Environmental Services
Building & Inspections Division
BUILDING PERMITPERMIT
FEES
P.O. Box 580 281 N. College Ave.
Building Valuation
Fort Collins, CO 80522-0580
City of Fort Collins
phone (970) 221-6760 Fax (970) 224-6134
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ACCOUNT
FEE
DATE PAIL
JOB SITE ADDRESS 214 JACKSON AVE
PERMITTYPE
PERMIT DATE
10 04/2005
Building Permit w/o Subs
$44.5
10/4/0
ELEC
PERMIT LEVEL CATEGORY TYPE
Electrical AlterWion ISSU_FUL Residential
Last Name, First, Middle
Initial
Construction Type Occupancy Group
uu Address
City/State
1L
in No. of Stories Building Height
O Zip
FORT COLLINS CO
O
V
80524
Phone No.
217-3635
Building Square Footage Stock Plan/Options
Front Setback
Rear Setback
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0
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Z
Z
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Right Side Setback Left Side Setback
Plat File No.
ZBA Case Number Zoning District
(See reverse side for Inspection Description)
rNE RE E0
Q
Subdivision/PUD Filing
wLot
Block Lot Area Parcel No.
OCompany
Name
0 7 420012
Contractor License No.
Address
City/State
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rZi
Phone
Supervisor Cert. No.
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License No.
TIS
Mechanics
License No.
O
Roofing
License No.
H
Z
Framing
License No.
V
SO
Plumbing
License No.
N
Concrete
License No.
INSTALL NEW PANEL,100 AMP TO REPLACE EXISTING - 2 NEW KIT CIRCUITS, WASHER CIRCUIT AND BATH
CIRCUIT
8
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 asgociated with such work. I understand that such permit may be revoked in the
event that issuance was based on incorrect or incomplete information. This It all become null and void if the work authorized by such permit is not
commenced, suspended, abandoned or inspected within 180 days fromth ate i tuch permit or from the date of the last inspection.
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Print name of owner/agent Signat a Date
rOTAI FEES 1 $44. !