HomeMy WebLinkAbout602 KEENESBURG CT - APPLICATIONS - 10/9/2003BUILDING PERNIITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
Last
First
Middle Phone
03
Street Address Please Specify: LN.
DR. CR. WY. PL. ST. CT RD. AVE.
City State Zip Code
Company Name
license Number
Supervisor & Cert. #
CSC—
Mailing Address
City
State Zip Code
Phone
Please Specify: LN. DR. CR.
WY. PL. ST CT RD. AVE. Zip Code
a one cur
Subdivision/PUD
C
l ew
'lI
';
Filing Number Lot
Block
Lot Area
,
Building Square Footage
Number of Stories
Building Height
Number of Dwelling Units
Number of Bedroo s/Bathrooms Unfini e ' ished Basement Sq. Ft.
o
�
Stock Plan Nu ber/Options
Rad
EnergyScore/E-Star/Air Sealing/Blower Door
lc i 3
0 Y Xv
s�
21
Water Tap Size
3 (� ��
Sewer Tap Size
Metered
Type f Heat:
Electric Main Breaker Size (Residential Only)
Temporary Electric Pedestal Requested:
Gas ❑ Electric
150 amp or less ❑ 200 amp ❑ other
Yes []No
(including labor, material, profit) $ , 1'7LP ►4t77, -1ct
Description of Work:
Job Contact Name &Phone #:
Bi 1 a 0 01 `10--4 lib- 7(06
Subcontractor Names:
Electrical I,+6 L-} Mechanical C-t 1 V,�,t>h k:b Plumbing } (k 01 fed in
Framer "L 5a rYll (lA Roofing �U Ip pp-j � ' Concrete 'h T Fp(,U�C�Ip�-�—��M S
II 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.
R
o.
Signature
Print Name C..Or'G,/ Phone 303->:GC-/83l
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE