HomeMy WebLinkAbout424 PINE ST - APPLICATIONS - 1/5/2005BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgoV.com
City of Fort Collins BUILDING PERMIT APPLICATION
Application Number �� � lJ 5 a Application Date
Last First
03 Street Address Please Specify: LW.' DR. CR WY. PL. ST CT RD. AVE.
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Company Name License Number
State Zip Code
s (!!�' a 0::)152y
Supervisor & Cert. #
Mailing Address
City
State
Zip Code
0
Phone
Please Specify: LN. DR. CR. WY. PL. ST CT RD. AVE.
Zip Code
JOB SITE ADDRESS
421f /101111-e-
Subdivision/PUD
LC
CM
Filing Number
Lot
Block Lot Area
.2-��
� 5"
Building Square Footage Number of Stories
Building Height
0
Number of Bedrooms/Bathrooms Finished Basement Square Footage
0
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Value of Construction (including labor, material, profit) $
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Description of Work:
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Subcontractors:
Electrical
Mechanical
Plumbing
Roofing
Concrete
Framer
I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all
requirements conta ed herein and city4dinances and state laws regulating building construction.
R
a SignatureCL
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Print Name � `�!� �i-� �g�( Phone sl6
Distribution: Original - L & P Yellow - Office
THIS APPLICATION EXPIRES DAYS FROM APPLICATION DATE
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