HomeMy WebLinkAbout420 PEYTON DR - APPLICATIONS - 5/6/20036 AiLod
City of Fort Collins
0-57— 7
BUILDING PERMTI's & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
Last First
i -tu 0 .
c Street Address Please Specify: LN. DR. CR. WY. PL. ST CT RD. AVE.
Lai `i.:x y CW*�M . S� A -
Middle
Phone
Zip Co
pump y ivarne
Liceepsee Numoer
Supervisdf & Cert. #
o
me
738
Mailing Address
City
State Zip Code
C.3
Phone
P ase
Specify: LN. DR. CR.
WY. PL. ST CT. RD. AVE. Zip Code
c
Subdivision/PUD <
t 4L
cm
°3
Filing Number 3J
Lot ( R iC) Block Q
Lot A LIP
Building, Footage
Number of Stories
ild�ing ei ht
`Square
4
L
Number of Dwelling
Number of Bedroo s/Bathrooms Unfinished/Finis ed Basement Sq. Ft.
y
`Units
Stock Plan Nu ber/Options
Rado
Ener $_core/E-Sta /AirSealing/Blowerpoor
Y/Al
r (
N
Water Tap Site
Sewer Tap lize
Metered
Type f Heat:
Electrlc Main Breaker Size (Residential Only)
Temporary Electric Pedestal Requested:
Gas ❑ Electric
A50,amp or less ❑ 200 amp ❑ other
Yes ❑ No
(including labor, material, profit) $
'4c�, , -7-7
Job Contact Name & Phone #:
- Vi aU- c1l7Q - 5AP 8
Subcontractor Names:
Electrical (- �,( }y� Mechanical 611hl 101 f Pa-h Plumbing
Framer Ir.A Roofing Concrete S� —j
c
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.
a Signature
CL
Print Name (�orcy N¢uvv- Phone
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE