HomeMy WebLinkAbout821 ROMA VALLEY DR - APPLICATIONS - 3/12/2003a=�2.
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-OSM • Phone: 221-6760
City of Fort Collins BUILDING PERMIT APPLICATION
0:6*0 womb"
Lasj First Middle Phone
CD H&kp
Sod — Z 3
c Street Address Please Specify: LN. DR. CR. WY. PL. ST. CT RD. AVE. City State Zip Code
r �e S c�SLS Ac�
Company Name License Number Supervisor & Cert. #
i ung Address City State Zip Code
Phone
Please Specify: LN. DR. CR. WY. PL. ST CT. RD. AVE. Zip Code w 1
JOB SITE ADDRESS T
Subdivi ion/PUD
Filing Number Lot Block Lot Area
v
Building Square Footage Number of Stories Building Height
o �iV 00
c.
0
y Number of Bed oms/V
oms Finished Basement Square Footape
2 C,
ZooFiN
Value of Construction (including labor, material, profit) $ r 000 , -3;:>.L
Description of Work-
Subcontractors:
Electrical c N.1� Mechanical lX— Plumbin
,\ 9
Roofing N Concrete Framer 4T446
I hereby acknowledge th t I have read thi ap is ion and state that the above information is correct and agree to comply with all
requirements contain in and ci na cT nd state laws regulating building construction.
o. Signature
r
aL4� / /
Print Name Phone V� ! q
Distribution: Original - L & P I Yellow - Office
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE