HomeMy WebLinkAbout4625 REGENCY DR - APPLICATIONS - 7/29/2003BUILDING PERNIITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
BUILDING PERMIT APPLICATION
First ,
Soy) Lyr L,n
Middle Phone
2c� ti wt ova 70 - e2 to -s
Street Address Please Specify: LN. DR. CR. WY. PL. -t.. CT. RD. AVE. City
Company Name License Number
N 0 v"(2) Lx) r�c�
Mailing Address City State
State Zip Code
06 �oS 2 Co
Supervisor & Cert. #
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Phone
Ct2Co - S L 6 C/
Please Specify: LN. DR. CR. WY. PL. ST. CT RD. AVE.
JOB SITE ADDRESS q(V2S
Zip Code
�v'C'Z Co
Zip Code
Subdivision/PUD
CD
Filing Number Lot Block Lot Area V
Building Square Footage Number of Stories Building Height
Z Z �.of f F't U•t L' S
Number of Bedrooms/Bathrooms Finished Basement Square Footage 1
Value of Construction (including labor, material, profit) $
Description of Work:
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C9ylcI 0cL-� OIns�-icLeLoAvea wos
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Minor
Subcontractors:
Electrical r( pllc- Mechanical `� l %� Plumbing l ( t1A
Roofing N ( A Concrete 1� �%� Framer tACG" o W o f
I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all
requirements contained herein and city Ordinances and state laws regulating building construction.
c ilhtl�&oa Signature7i1
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Print Name L o tr v'y)r- C-0-so a) Phone Ct70--Z2(Q - Z C& Cl
Distribution: Original — L & P Yellow — Office
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE