HomeMy WebLinkAbout909 CENTRE AVE - APPLICATIONS - 5/19/2004 (2)............
City of Fort Collins
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 224-6134
BUILDING PERMIT APPLICATION
L #
First
Middle Phone
�- 4��
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Street Address Please Specify: LN. DR.
CR. WY. PL. ST CT. RD. AVE.
City State Zip Code
/ o f
_
41 j �0 2Co
Company Name
License Number
Supervisor & Cert. #
o
1 N
T- 1
R
Mailing Address
_P
City
State Zip Code
o
2 2 2
U-4
C.CJ -5-2
CS
Phone
9,-Lo, 204, o/oo
Please Specify:
LN. DR. CR.
WY. PL. ST CT Q AVE. Zip Code
Subdivision/PUD a2r oc- TrkA4
$40 Lairec.. r-o,e Aav,6,-g
Lj j, FOR-T oCD
Filing Number Lot
Block of Area e
Building Square Footage
INumber of 5tories
Jf Bu ilding Height
/43 S�
07 TO Tr0676-
i
Number of Dwelling Units
Number of Bedrooms/Bathrooms Unfinished/Finished Basement Sq. Ft.
y
A,
,
Stock Plan Number/Options
Radon
Energy Score/ E-Star/ it Sealing/Blower Door
Y/N
H
Water Tap Size
Sewer Tap Size
Metered
Type of Heat:
Electric Main Breaker Size (Residential Only)
Temporary Electric Pedestal Requested:
❑ Gas ❑ Electric
❑ 150 amp or less ❑ 200 amp ❑ other
I 4Yes ❑ No
1 1 1 (including labor, material, profit) $ I LS 000�1,To.� t3j O�
Description of Work: r____
S
Job Contact Name &Phone #: �UG
fill c 970 20 . o ioy
Subcontract r Names:
Electrical 2�,p�y ��, Mechanical ^VA Plumbing
Framer A Roofing N A Concrete
I hereby ackr
10
requirements
R
w
'Q Signature
a
that I have read this applic ion and state that the above information is correct and agree to comply with all
�here�nd city, ordiinanc and state laws regulating building construction.
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE