HomeMy WebLinkAbout608 KEENESBURG CT - APPLICATIONS - 9/19/2003I
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City of Fort Collins
BUILDING PERNIITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80572-0580 • Phone: 221-6760 • Fax 22A-6134
BUILDING PERMIT APPLICATION
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reet Address Please Specify:
LN. DR. CR. WY. PL. ST. CT. RD. AVE. City
State Zip Code
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CgMpany Name
License Number
Supervisor & C rt. #
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Mailing Address —`\
City State
Zip Code
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Phone
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Specify:
LN. DR. CR. WY. PL.
ST. CT. RD. AVE. Zip Code
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Filing N
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Lot
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Buildin Square Footage
Number of Stories
uilding Height
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Number o welling Units
Number of Bedroo s/Bathrooms
Unfinished nish d Basement Sq. Ft.
StockPlan�mber/O tions
Rad
Energ Score/E-Star/AirSealing/Blower Door
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Water Tap S
SewerTa Size
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Metered
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Type f Heat:
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' Main Breaker Size (Residential Only)
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p rary Electric Pedestal Requested:
Gas ❑ Electric
X150
amp or less ❑ 200 amp ❑ other
Yes ❑ No
(including labor, material, profit) $
Description of Work:
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Job Contact Name & Phone #:
Subcontractor Names: ' l .
Electrical Mechanical GI� Cif1�1 Plumbing t111 P
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Framer IL� (,•1-t( WlY? Roofing MV° n0PA:jQLQA Concrete"�4�i t jai OCOYlz
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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.
Signature
Print Name Cow / oie ,e✓ Phone � - ¢GG-Ieyl
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Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE