HomeMy WebLinkAbout4380 ZIEGLER RD - APPLICATIONS - 5/27/2004BUILDING PERmrrs & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-OSM • Phone: 221-6760 • Fax 2M4134
BUILDING PERMIT APPLICATION
Last First 0C Middle
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cStreet Address Please Specify: LN. DR. CR. WY. PL. ST. CT. RD. AVE. City State
Q 0 NY, %713 l OUSTor1 ( x
C,Qmpany Name r" „ License Number Supervisor & Cert. #
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iling q�dress
VZAWE2
U"Mil V-LAU 10111 W- /R - 1
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State
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LO
Phone
9--io-2Zl-+95
Please Specify: LN. DR.
CR. WY. PL. ST.
4300 &ALE- -tv . nvr
Lowto5
Subdi oq/PUD?
Filing Number
Lot Block
Lot Area
2uo
Building Square Footage Number of Stories
of welling Units
0 Ar
N Water Tap Size
d
rr
AVE.
"D-288.t6t
Zip Code
77ZZ7
Zip Code
805ZZ
Zip Code
y�SZP�
• 10 AG
Building Height
N/A
M
I` J
Type of Heat: Electric Main Breaker Size (Residential Only) Temporary Electric Pedestal Requested: `�,
❑ Gas ❑ Electric ❑ 150 amp or less ❑ 200 amp ❑ other ❑ Yes X No
r M (including labor, material, profit) $ 315 , M0
Description of Work: 55 t t n G.-
Zpuis 4 - i d I -Gory A A l7tt t�[r m Gwwn iZ CaLlr t4uj r PkacA(
Y/N
of
Job Contact Name & Phone #:
Z
Subcontractor Names:
Electrical tItYU02 VLEGTatc. Mechanical 0/A Plumbing NI&
Framer MIA Roofing of& Concrete IZL 4CAN C xlsr .
I hereby ackno ledg ha I have this application and state that the above information is correct and agree to comply with all
requirements co tain in a d i ordinance state aws regulating building construction.
a Signature
a
Print Name UntJ IA& CA Phone °I'10 ZZ1-'-IigS
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE