HomeMy WebLinkAbout4702 DUSTY SAGE LOOP - APPLICATIONS - 11/7/2003 (2)BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
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Street Address Please
Specify: LN. DR. CR. WY. PL. ST CT RD. AVE. City State
Code
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Company Name
License Number Supervisor & Cert.
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Mailing Address
City
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Zip Code
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Please Spec LN. DR. CR. WY. PL. ST. CT. RD. AVE.
Zip Code
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Sub 'vi ion/PUDO
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Filing Number
Lot r /� Block Lot Area
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Building Square Foot a a
Number of Stories
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Building Height
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Number of Dwelling Units Number of Bedrooms/Bathrooms Unfin'
d Basement Sq. Ft.
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Stock Plan Number
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Water Tap Size
Sewer Tap Size
Metered
CID
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Type eat:
Electr' ain Breaker Size (Residential Only)
Tempor Electric Pedestal Requested:
Gas ❑ Electric
Ef 150 amp or less ❑ 200 amp ❑ other
Iff Yes ❑ No
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(including labor, material, profit) $
Description
of Work: _ _
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Job Contact Name & Phone #: �71")
Subcontractor a es: y ` �,�
Electrical �/�,��,/.��. Mechanical �f:/�J/G� /0/65//-g lPlumbing
Framer C�,iryve Roofing_.�,nir'!��✓l��✓p"Q#W
I hereby acknowledge that I have
requirements contained herei
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a Signature
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Print Name
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that the above information is correct and agree to comply with all
s regulating building construction.
Phone 778 0 Z Z, 13 y
Distribution: White - office Yellow - Applicant Pink - WWW/Stormwater