HomeMy WebLinkAbout4721 Dusty Sage Loop - Applications/Basement Finish - 11/22/2006BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: Z21-6760
WWW.fcgov.com/building
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CityofFort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER �4 APPLICATION DATE
Job Site Address y-721 DVS4 Skego Loop 40 Z t #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # o
Last Name g4 N T-Ar First Name TD R Middle
Street Address `i7721 bus Ty lAwp # I? City d4j—n &mGLr State�_Zip AOSZ�
CONTRACTOR INFO: Company Name /ikQ /iLKL6U,9 fr R V I l"P95r1kctor Phone #aj g -1
Lic. Holder Name g rfAT SM1' ��(J City of Fort Collins License #r) ?h3g Supervisor Cert #
Mailing Addressp-e2p f tdsx �:S:i City )A7, GdLL/Iy� State 4:05d Zip gkq.5Z
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1st Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft /'Z
# of Bedrooms I # of Full Baths _�_ 3/, Baths 1/ Baths # of Fireplaces
Air Conditioning: Yes No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
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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
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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): ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ 3 %, (000
Description of Work: fe liQ 1 to h FA w t I^v ,i4 Ar �� J71 i i ft1� k a,mnA
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Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical A ZY Ill Mechanical /� f} Plumbing x j�� f/4
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Framer � �+ r7T�J�RT Roofing ._--^ Concrete Other r—
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 ordinan es and state laws regulating building construction.
Applicant Signature Print Name k l t &7T
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE