HomeMy WebLinkAbout619 BLUE MESA AVE - PERMITS - 10/1/2003Community Planning &Environmental Services
FEES
Building & Inspections Division BUILDING P E RM I TPERMIT
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 3 0 2 2 6
ACCOUNT
FEE
DATE PAID
JOB
SITE ADDRESS
PERMIT DATE
.r003
619 BLUE MESA
1C 01
Plan �lleck Fee
Bui )ding Permit w/ Subs
$52.3
$108. 6
5/1/C3
10/ 1 /03
PERMIT
TYPE
RALAD Res Alteration/Addition
PERMIT LEVEL
!SSU_FUL
CATEGORY TYPE
Residential Remodel
Last Name, First, Middle Initial
Construction Type
Occupancy Group
w
n;t C 1.1 T
City SalesrUse Tax
b
$150.0
!
10111111031
Address City/State
619 1111 I
No. of Stories
"
Building Height
Z
Z
3
Q
O
JE MESA AVE FORT COLLINS, CO
zipV
o
2
0
County Sales/Use Tax
$40.0
10/1/03
Building Square Footage I Stock Plan/Options
Phone No.
80526-2705 223-4454
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)
Subdivision/PUD
RL
Filing
5 o c n P � M
J
WOODWEST 7
wa
G� IN FN8
Lot Block Lot Area Parcel No.
10677 9726324005
Name Contractor License No.
FNF FNP FNM
F D leiP I U 0 P
OCompany
UAddress
F !i F r i E
City/State
H
ZZ
Phone Supervisor Cert. No.
V
Electrical License No.
W
0
Mechanical
License No.
Roofing
License No.
H
Framing
License No.
Z
0
V
Plumbing
License No.
N
Concrete
License No.
RESIDENTIAL ADDITION - CONSTRUCT 126 SQ FT OF LIVING AREA (MASTER BEDROOM) ABOVE EXISTING
GARAGE AND CONSTRUCT COVERED DECK NEXT TO ADDITION.
LU
HOMEOWNER AFFIDAVIT ON FILE
11
Review by KM
f*1
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 fro the date of suc ermit or from the date of the last inspection.
elf-O
L 4 ��1 r•� t
name of owner/Agent Signature Date
Print
TOTAL FEES
$351 0