HomeMy WebLinkAbout6227 GOLDEN WILLOW DR - APPLICATIONS - 9/24/2004a;
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
Last First Middle 7 Phone
ai
c
StreeTAddress Please Specify: LN. DR. CR. WY. PL. ST CT. RD. AVE. City State Zip Code
pan ame
Lic sg N� ber
S rvisor & Cert. #
��%
2
S
Mailing Address
Ci y State ZipCode
�L Z
C.3
Phone
2
Please Specify: LN. DR. CR. WY. PL. ST CT RD. AVE. Zip Code
l0 ` :& � rjasj
R
- Subdivision/PUD
o+CA
C�
Filing Number Lot Block Lot Area L
o
Building Square Foota a Number of Stories Byj�ding/Height
I ��G
LNumber
of Dwe lin Units Number o B droQms/Bathrooms nfinis d/FinishedddBBasement
N
,
St c lanumber/Option s Radon Energy Score/ - it Sealing/Blower Door
l Y/
ti
Water Tap Size q rt Sewer Tap Size etered
_d
Type of Heat:
Electric Main Breaker Size (Residential Only)
Temporary Electric Pedettal Requested:
Gas ❑ Electric
(150 amp or less ❑ 200 amp ❑ other
JVNes ❑ No
Kl(including labor, material, profit) $
Description of Work: ,4
ZA4:>�'Zer-i
2) -�;^ �—
Job Contact Name & Phone #:
Subcontractor Names: % 7
Electrical Mechanical g
Framer Roofing C Concrete
ASP F ttlt C�IM �etx t D I004 re Gate
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 a e laws regulating building construction.
C
A `
w
a Signatur
a
Print Name Phone
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE