HomeMy WebLinkAbout419 W MOUNTAIN AVE - APPLICATIONS - 1/31/2003City of Fort Collins
BUILDING PERMITs Bit INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
Last
First
Middle Phone
ULfa
_p c
CDStreet
Address Please Specify: LN. DR. CR. WY PL. ST CT. RD. AVE.
City State Zip Code
ZjZ Ill
nt- i
2
Company Name
License Number
Supervisor & Cert. #
Mailing Address
City
State Zip Code
Z tJY6Q
GD . S
c5
Phone
Please
Specify: LN. DR. CR.
WY. PL. ST CT RD Zip Code
0.rF
Z
Subdivision/PUD
CD
Filing Number
Lot Block
Lot Area
,E35
01
7000
Building Square Footage
Number of Stories
Building Height
Z I o
2
_ �,t
Number of Dwelling Units
Number of Bedroo s/Bathrooms Unfinished/Finished Basement Sq. Ft.
ca
A S.cs•
a
Stock Plan Number/Options
Radon
Energy Score/E-Star/Air Sealing/Blower Door
Y / N
d
WaterTap Size �t
SewerTayPize
Metered
Type of Heat:
Ele�ct�ri Main Breaker Size (Residential Only)
Temporary Electric Pedestal Requested:
XGas ❑ Electric
,�150 amp or less ❑ 200 amp ❑ other
,l�Yes ❑ No
1 1 W1111111111HE (including labor, material, profit) $ L l 5 Z4Qp , —
Description of Work: ,
C-^
Job Contact Name & Phone #:
Subcontractor Names:
Electrical Mechanical}-(1EEDS L Wj5(, 1/ � Plumbing .
Print Name
Concrete
on and state that the above information is correct and agree to comply with all
and statg laws regulating building construction.
•III&PIU19A
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE