HomeMy WebLinkAbout121 S WHITCOMB ST - APPLICATIONS - 3/2/2020City of
Frt Collins
Community Development and Neighborhood Services
281 N College buildingservices@fcgov.com
Fort Collins, CO 80524 970-416-2740
11 A01,
Application # j^^=2c%'a /-7 -7 l
Date Received ✓ u �'�`���
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Job Site
Address
ALL information is REQUIRED. Incomplete applications will not be accepted.
Property Owner Information�,�
Name_ �cCx QOwk w Phone Number
Address 1 d k 4b• WllutCzYV\'b
Value of Work
Labor and Materials $
Scope of Work
® Single Family Detached Q Townhome (attached) Q Duplex
City/State/Zip-Vt• CZ W11%A IJ.J
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City/State/Zi7ric• COMA e.0
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Q Bank Q Bar p Church p Hotel/Motel Q Medical Office Q Office
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Q Sewer line replacement / new
Q Water line replacement / new
6 Gas line replacement new
p Other plumbing work
Feet to be replaced / installed
Feet to be replaced / installed
Feet to be replaced / installed a+pa -A 35
O Garage/Other
Q Retail Q Restaurant
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Additional Information ` .
(if applicable)
Plumbing
Name
Address MW �111j�/r�(-� s O.Aw f' , ,Ciity//State/Zip, ®{f'1�`,il—1 L 11�kJ1, l
PhoneNumber�n - (Aal9"Qe26( G Email Qsmmnw T CIt)a .-;hb /, L43»A ��
License Number T Lri — n 1 4 — C� R ^ Lo ro — � -1 J
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Print Name Date