HomeMy WebLinkAbout812 Sitka St - Applications/Single Family New - 12/26/2006-- BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 8052Z-0580 • Phone: 221-6760
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City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER D L(L �/T APPLICATION DATE
Job Site Address n`5�I )— V�) i�-�O- Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last Namec( i� ���� First Name�� 1 1� Middle 1(/t? f11_
Street Address�-1'05n IE h a-Ax— CitState , Zip
CONTRACTOR INFO: Company Name Contractor Phone #
Lic. Holder Name
Mailing
LEGAL INFO:
City of Fort Collins License # Supervisor Cert #
City State Zip
Subdivision/PUD C VtU �f Q � QQ�\� Filing # 72- Lot # ZE) Block #- (.P-- Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) CamO Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft-JIN4 # of Stories Bldg Height # Dwelling Units
15' Floor Sq Ft J `) _ 2nd Floor Sq Ft _Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft L.IT _
# of Bedrooms # of Full Baths 7 1/4 Baths t�J '% Baths # of Fireplaces
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I V
Air Conditioning: es 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 #
UTILITIES INFO:
List appropriate option #s
Water Tap Size I /r Sewer Tap Size -4 Metered: eor No Temp. Pedestal: Yes or No
Type of Heat: )I Gas ❑"Electric Electric Main Breaker Size (Residential only): g150 Amp/ or Less ❑ 200`Ammpp �❑ Other
Value of Construction (including labor, material & profit) $ (DQ , c Cnn + I 't a 5l0 7
Description of Work: )V��Q��`� (33A6.
Contact Name & Phone # of JOBSITE SUPERVISOR: - Jlr \ _ \(I ( 1l NOY )i
Subcontractor Info: 90 704 _ 5
i
Electrical Mechanical Plumbing
- DIS'r7n1GT(VE VI
Framer & ofing oncrete QR,ft57861 Sc)n\ Other
Applicant: I reby acknowledge at I have read this application and to that the above information is corrrrreeL�nd agree to comply with all requirements
contained herein a City of Fort o ' finances and state laws reg ating building construction.
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Applicant S� ture Print Name�S014 Ksn� Phone 3b3-657-8?-q(o
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE