HomeMy WebLinkAbout5421 Northern Lights Dr - Applications/Basement Finish - 03/26/200933
BUILDING PERMITS & INSPECTIONS DIVISION �Ll'�
EO. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 I "
www.fcgov.com/building
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER I� O t -7, APPLICATION DATE w !O
Job Site Address t/ k'CS �`� 105UUnit#
PROPERTY OWNER INFO: (All owner information is required - itis
Liss not optional) Phone #� I J Z 7
Last Name �' -First Name I.• �Rn LA S �J� 11 Middle
Street Address h ��'� 4j 6 A ��� S `1>' City E, (+ C(A km State Zip 2
CONTRACTOR INFO: Company Name Contractor Phone #
Lic. Holder Name City of Fort Collins License # Supervisor Cert #.
Mailing
City,
LEGAL INFO:
Subdivision/PUD , I �W �u� (�, vFiling �#:—A) Lot # 306
CONSTRUCTION INFO: Total Building Sq t (not including basement) Z 3M
State Zip
Block #_W Lot Sq Ft) 03 .41 ix
Total Garage Sq Ft
Residential Sq Ft Comml Sq Ft # of Stories Bldg Height # Dwelling Units
1st Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq Ft I 0 9 3 Finished Bsmt Sq Ft r0 O C9
# of Bedrooms # of Full Baths 3/-Baths '/Z Baths # of Fireplaces
Air Conditioning: Yes No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # List appropriate option #s
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered. Yes or No Temp. Pedestal: Yes or No
Type of Heat: Gas ❑ Electric Electric Main Breaker Size (Residential only): cam' 50 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material -& profit) $ A0 3(SD
Description of Work: 71a S p yyV_ n-1!- �'i� f sy l
Contact Name & Phone # of JOBSITE SUPERVISOR: Mom-?CQ 0IL01-5 0 Al q-7 O !'2t _5 02
Subcontractor Info: -
Electrical Mechanical
Framer. Roofing
%/ Plumbing
Concrete ar COVl re• e Other
Applicant: 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 of Fort Collin ordinances and state laws regulating building construction.
Applicant Signature Print Name Phone nt 76
Distribution: White - Office Yellow - Applicant Pink - VWVW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE