HomeMy WebLinkAbout614 E VINE DR - APPLICATIONS - 6/17/20036iABUILDING PERMITS BS INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
City of Fort Collins BUILDING PERMIT APPLICATION
Application Number Application Date
Last First Middle Phnna
CD
/� ,-e-
l e- zdS
c
Street Address Please Specify: LN DR. CR. WY. PL. ST. CT RD. AVE. City State
Zip Code
Company Name
License Number Supervisor & Cert. #
o
R
Mailing Address
City State
Zip Code
o
r
/ T /
(�-e
Phone
�5?/
Please Specify:
LN. DR. CR. WY PL. ST CT RD. AVE.
Zip Code
JOB SITE ADDRESS
Subdivision/PUD
a
CM
°i
Filing Number Lot
Block Lot Area
Building Square Footage
Number of Stories
Building Height
0
L
aNumber
of Bedrooms/Bathrooms
Finished Basement Square Footage
c')
Value of Construction (including labor, material, profit)
Description of Work:
Subcontractors:
Electrical
Mechanical Plumbing
Roofing
Con cretei�j/,4 �5�.� . Framer
I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all
requirements c d herein and city or inances and state laws regulating building construction.
'a Signatu�Of--
a
Print Name Phone ��� — 38 7/
Distribution: Original — L & P Yellow — Office
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE