HomeMy WebLinkAbout909 CENTRE AVE - APPLICATIONS - 5/19/2004 (7)BUILDING PERNM &c IwEcnoNS Dmsm
P.O. Box 580 - Fort Collins, CO 00522-WM a Phones 221-6760 • Fax 224-61M
BUILDING PERMIT APPLICATION
Application Number
Las First
Middle Phone
L
cStreet
Address Please Specify: LN. DR. CR. WY. PL. ST. CT RD. AVE.
CI y State Zip Code
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L ,i45 e(D 640
.-Company Name License Number
Supervisor & Cert. #
`o
ailing Address City
State Zip Code
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Phone
00,4 . 0/00
Please Specify: N. DR. CR.
WY. PL. ST CT RD. AVE. Zip Code
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filing Number Lot ock
Lot Area _ 60
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Building Square Footage NurAber of Stories
Building Height
l
Number of Dwelling Units Number of Bedrooms/Bathrooms Unfinished/Finished Basement Sq. Ft.
A
Stock Plan Number/Options Radon
Energy Score/E-Star/Air Sealing/Blower Door
Y/N
Water Tap Size Sewer Tap Size
Metered
N A A
Type of Heat:
Electric Main Breaker Size (Residential Only)
T❑
Temporary Electric Pedestal Requested:
❑ Gas ❑ Electric
150 amp or less ❑ 200 amp ❑ other
llifYes ❑ No
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Description of Work:
L
4�;CAP S
Job Contact Name & Phone #:
n�i hL4 970. 204 - o rocs
Subcontracto Names:
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Electrical ,fZc,rGc
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, Mechanical Plumbing
Framer ,�
Roofing r� Concrete ._ 04-,4,;)4
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AMP Fault Current
i ce fy 1)Iaaigltallon "gip i
IIate
L
T/M
i hereby ackn Arledge that I have read this applic i n and state that the above information is correct and agree to comply with all
requirements c ntaine her an dinanc and state laws regulating building construction.
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a Signature
Print Name&A�7 l-•_ Mq t"k-lV Phone � � 00f - 0 wv
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Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE