HomeMy WebLinkAbout612 BALSAM LN - PERMITS - 9/16/2005Community Planning &Environmental Services
Building & Inspections Division BUILDING PERMITPERMIT
P.O. Box 580 281 N. College Ave.
Building Valuation
Fort Collins, CO 80522-0580
City of Fort Collins phone (970) 221-6760 Fax (970) 224-6134 B0505371
$1,2rJ2.��
ACCOUNT
FEE
0ATE 'AID
JOB
PERMIT
SITE ADDRESS 612 BALSAM LN
TYPE
PERMIT DATE
09/ 16/2005
Building Perwit w/o Subs
$15.0
9/16/05
WTRHTR Water Heater PERMIT LEVEL ISSU—FUL
CATEGORY TYPE
Residential
Last Name, First, Middle Initial
JAMES
Construction Type
Occupancy Group
CACCREED,
w
Address
S BARRY RD C ty/State
COLUMBIA, MO
p
p
No. of Stories
Building Height
0
Zip 65M1-9235 Phone No.
Bile
uding Square Footage
Stock Plan/Options
Front Setback Rear Setback
0
Z
• •
Right Side Setback Left Side Setback
I*4
Plat File No. ZBA Case Number Zoning District
Subdivision/PUD Filing
(See reverse side for Inspection Description) p p on)
F N P
Q
JLot
Block Lot Area Parcel No.
p 9123205035
Company Name Contractor License No.
W
Address City/State
0
Phone Supervisor Cert. No.
V
Electrical License No.
OMechanical
License No.
Roofing
License No.
Z
Framing
License No.
V
Plumbing
License No.
y
ALLEN PLUMBING & HEATING
MP 4
Concrete
License No.
INSTALL WATER HEATER
As a
condition for the issuance of a permit, I hereby declare that I am an owner or the owner's agent, authorized to perform the proposed work on the property
described
herein. I agree to comply with all City ordinances, and State laws associated with such work. I understand that such permit may be revoked in the
event
that issuance was based on incorrect or incomplete information. This permit shall become null and void if the work authorized by such permit is not
commenced,
suspended, abandoned or inspected within 180 days from the date of such permit or from the date of the last inspection.
name of owner/agent Signature Date
Print
TOTAI FEES
$15.