HomeMy WebLinkAbout3317 SHALLOW POND DR - APPLICATIONS - 9/16/2003-7 MOP
City of Fort Collins
C-1Z4/-� 130/-)
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 a Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
Last First
Middle
Phone
CD
4To- GG 7- l3�
c
Street Addr ss Please Specify: LN. DR. CR. WY. PL®CT RD. AVE.
City
State Zip Code
/D7 LvZtPt4G zio
�,/s 3�
Company Name License Number
Supervisor & Cert. #
0
Mailing Address City
State
GD
Zip Code
.O•�!rt�Z�tS
S
Phone
Please Specify: LN.
0. CR. WY PL.
ST. CT RD. AVE. Zip Code
-7
Subdivis n/P
FiCM
ling Number Lot Block
Lot
ea
Building Square Foota a Number of Stories
Building fight
Number of Dwelling Unit Num Bedroo
/Bathrooms
Unfi is F' ed Basement Sq. R.
y
e
s
Stock Plan Numbe Options Radon
Energy Score/ E- it ealin ower Door
N
Water Tap Size „ SewerTap
ize
ej Metere-V
O!
3
Typf V Heat:
Electric Main Breaker Size Residential Only)
Temporary Electric Pedestal Requested:
Gas ❑ Electric
❑ 150 amp or less'ff 200 amp
❑ other
Yes ❑ No
1 1 1 (including labor, material, profit) $ 2F36. Sl/o,
Description of Work: . ,
Job Contact Name & Phone #:
f%/%i•,ylr le!5)Pleo�
Subcontractor Names:
Electrical /�jezdGyy, Mechanical �cP1dl" Plumbing
Framer/A�-1,�Lo� Roofing,Bi�� Concrete
�o
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.
R
V
o.
Signature,��
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Print Name .!%�%i-.fC �,o �c�rS Phone
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Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE