HomeMy WebLinkAbout612 REPUBLIC DR - PERMITS - 12/16/2005Community Planning & Environmental Services
Building & Inspections Division BUILDING P E RM I T
PERMIT 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 B 0 5 0 7 3 4 3
ACCOUNT
FEE
DATE PAID
JOB SITE ADDRESS 612 REPUBLIC DPERMIT DATE
R
PERMITTYPE 12/ 16/2CC�,
Building Permit w/o Sub
;15.
0 12/16/0
WTRHTR Water Heater PERMIT LEVEL CATEGORY TYPE
ISSU_FUL Residential
Last Name, First, Middle Initial
City Sa)eslIke Tax
1)it.
$' i2/i6%�
Construction Type Occupancy Group
Ce LO, CHIN TEH/WU MEI
Address City/State p
County Sales/Use Tax
$2.
5 12/ 16/0
No. of Stories Building Height
ssss 612 REPUBLIC DR FORT COLLINS, CO O
zip 80a2s-2745 Phone No. V Building Square Footage 01 Stock Plan/Options
Front Setback Rear Setback
_Z
Z
Right Side Setback Left Side Setback
• •
Plat File No. ZBA Case Number Zoning District
(See reverse side for Inspection Description)
Flip
Subdivision/PUD
Filing
Q
�j
Lot
JC
Block Lot Area
Parcel No.
9726312012
OCompany
Name
Contractor License No.
Address City/State
OPhone
Supervisor Cert. No.
V
Electrical
License No.
OMechanical
License No.
Roofing
License No.
O
Framing
License No.
m
Plumbin
Ct�IURTESY PLMBC & DNAIN SVC
License No.
MP 322
Concrete
License No.
REPALCE 40 GAL N/G WATER HEATER FOR A 50 GALLON WATER HEATER.
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.
Print name of owner/agent Signature Date
TOTAL FEES