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City 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 Address927 JAMS COUTt
Name rimbifte=at 'Into
es
3
Mail Address 1113 -StOW Hill Drive
Port collinso CalorAde 80525
Phone 77,1..467,2
Name Allan Plumbing 1 Heating
o`
Addressgdq South Link Lane
0
r P r c a. 11
License No. Mill
Phone 4"-4$41
a
Lot
Block Filing Number
m
Subdivision
m
J
PUD
DESCRIPTION OF WORK
Reglacemnt of voter heater
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.
`l
signed "-" date
— CLASS OF WORK —
New Alteration Addition Demolish Move
❑ ❑ ❑ ❑ ❑
Plbg. Mach. Elec. Struct. Fire Prot.
'El• ❑ ❑ ❑ ❑
COO. Gr. Type Const.
Use Zone
Use of Building
Floor Area
Stories
Lot AreaOcc.
load
LHeightNo.
Occ. Change
Plat File No.
NGarage
area
FiType
heat
N
— RELEASES — Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation
FEES
Permit
_
Plan Check
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
City Sales Tax
Total Fees
-,
Permit No. Date
FU 2,1
ZBA Case #
BBA Case #
Date
Date
,Approval
''sate
Off -Street Parking
(No. Cars)
Interior Lot ❑
Corner Lot ❑
Reversed Corner Lot ❑
A
ID
m
`m
VV
t I f )
_1D
m
`c
0
LL
Street
H ii
Distribution: Original - Applicant, Blue - Office, Canary - Sales Tax; Pink - Applicant; Tag - Bfi Insp.