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of Fort Collins BUILDING INSPECTION DIVISION
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only.
Press firmly using ball point pen.
Job Address " , t
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Name 4,- 1 �f ` f �E ,
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Mail Address
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Name
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Address i - tl '. tG 3.4P
License No. `,f .;
Phone
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Lot
Block
Filing Number
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Subdivision
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PUD
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DESCRIPTION OF WORK
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Stock Options
Plan No. Codes
Est. Total Cost
(including labor, material, profit)
I hereby acknowledge that I have read this application and
state that the above is correct and agree to comply with all city
ordinances and state laws regulating building construction.
signed date F
tT_otal Fees
Off -Street Parking
(No. Cars)
Interior Lot
❑
Corner Lot
❑
Reversed Corner Lot
❑
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Street
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ZBA Case #
Date
BBA
Case #
Date
Building Insp. Approval
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by
1' date
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