HomeMy WebLinkAbout6315 CLYMER CIR - APPLICATIONS - 7/30/2004BUILDING PERMrrs & INSPECTIONS IiIVISION
City of Fort Collins
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 • Fax 224-6134
www.fcgov com
BUILDING PERMIT APPLICATION
Company Name
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Su erviso & Cert. #
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Mailing Address
City State Zip ode
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Phone
Please Specify: LN. DR. CR. WY. PL. ST. CT. RD. AVE. Zip Code
Subdivision/PUD
C
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Filing Nu�ber
Lot Blo k
Lot Area
Building Square Footage
Number of Sto es
Building Height
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Number of Dwelling Units
Number of B drooms/Bathrooms Unfinishe 'nished Basement Sq. R.
VlLA
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Stock Plan Numb r/Options
Radon
EnergyScore/E-Star/Air Sealing/ owerpoor
Y/
y
Water Tap Size a
Sewer Tap Size
Met red
Type of Heat:
Electric Main Breaker Size (Residential Only)
Temporary Electric Pedestal Requested:
t0as ❑ Electric
❑ 150 amp or less )j 200 amp ❑ other
Yes ❑ No
1 1 1
(including labor, material, profit) $
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59 Description of Work:
IF
Job Contact Name & Phone
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Subcontractor Names:
Electrical �t �S.s� Mechanical kt C t Plumbing / !M'Pl� &A 1YV9
Framer S \LOA-� Roofing Tip (may ►-Z Concrete ( n oo� >,r
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.
:o
'n Signature
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Print Name L S�t Phone �` -&Sod
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE