HomeMy WebLinkAbout4120 Center Gate Ct - Applications/Basement Finish - 10/12/2006BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
City of Fort Collins BUILDING PERMIT APPLICATION.
APPLICATION NUMBER D6o4� � APPLICATION DATE 1 0 -- / p_- O (0
—Job Site Address 4/,-2 O rGr Unit #
�. PROPERTY OWNER INFO::/ wt(All owner information is required - it is not optional) Phone # cf ?./�f— 4c3 %2
Last Name_First Name. "oll `' Middle
StreetAddressr�/QIT�T �i City �T//QT-GOL(��5 Statee;�-p Zipc
C CTOR INFO: Company Name Contractor Phone #
Lic. Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address it State Zip
L INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building q ncluding basement) Total Garage Sq Ft
Residential Sq Ft Comm] Sq Ft ies Bldg Height # Dwelling Units
1st Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft lj �3 ` C J
# of rooms # of Full Baths 1/4 Baths /3 Baths # of Fireplaces
Air Conditioning: Yes Energy info: (circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. E-Star w/Blower Door Live w/Air Sealing �63Pescriptive w/Blower Door
City of Fort Collins Stock Plan # List appropriate option #s
Water Tap Size Sewer Tap Size
Temp. Pedestal: Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size Residential only): El150 Amp or Less
_Value of Construction (including labor, material & profit) $ 4 � I Div' ,
— Description
Contact Name & Phone # of JOBSITE SUPERVISOR:
— Subcontractor Info:
Electrical
Mechanical
�NG
Other
Framer Roofing Concrete 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 Collins ordinanc nd state I s regulating building construction.
/J,
Applicant Signature Print Name J/At 1/ 1W&*1,4C 1N Phone
istribution: Wgiote — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE