HomeMy WebLinkAbout221 E LINCOLN AVE - APPLICATIONS - 1/9/2004City of Fort Collins
BUILDING PERMITS & INSPECITONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
Last Ma
�
First
Middle Phone
517-
03
Street Address Please Specify: LN. DR. OR. WY. PL. ST CT. RD. AVE.rr City State Zip Code
Company Name
License Number Supervisor & Cert. #
Mailing Address
9(�P
City
aUp-ail:F��z��.�.�5
ate Zip Code
-
0
o
6
Phone
1 5
Please
Specify:
LN. DR. OR. WY. PL. ST. CT. RD. AVE)Zip Code
17Su
E.sion/PUD
o�umber
Lot
Block Lot Area
Building Square Footage
Number of Stories Building Neight
Number of Dwelling Units
Number of B dZ
m s/Bathrooms Unfinished/Finish Basement Sq. Ft.
i
0
Stock Plan Number/Options
Rad Energy Score/ E-Star/ it Sealing/Blower Door
Y N o'
Water Tap Size I «
SewerTap Size Metered
H
T
I
Y5
Type of Heat:
Electric Main Breaker Size (Residential Only)
Temporary Electric Pedestal Requested:
as ❑ Electric
❑ 150 amp or less ❑ 200 amp ❑ other
Yes ❑ No
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Description of Work: n
141 AJ S Q��T�
Job Contact Name &Phone #:
5Ea r-.-) R a 6►E,c, s 4 4 0- /9ss
Subcontractor N es: (� '
Electrical LAcCT-2- Ell, A--. Mechanical At,?,CA",F&Q,-r Plumbing LLj-,,J 4 H
Framer is ( Roofing _ ��jb Concrete
I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all
requirement containty ordinances and state laws regulating building construction.
CL ure
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Q
Print Name- � 6.4•.� (�a�,Fe.S Phone `7g0 - ��55
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE