HomeMy WebLinkAbout2145 Nancy Gray Ave - Applications/Single Family New - 01/23/2007BUILDING PERMITS & INSPECTIONS ❑IVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
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WNW_ www.fcgov.com/building
CitYofFort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER APPLICATION DATE
Job Site Address
PROPERTY OWNER INFO: (All owner information is required - it is not optional)
Last Name , )Qs 4J0l %/iCfi First Name
Unit #
Phone # 34.3-- S/_9_3 - 94 z%
Middle
Street Address 's(`Z/ y YL 112 p�� % �'' /a li� City �Li �i State 6d Zip 20zal
CONTRACTOR INFO: Company Name �.P' J1FD7riIL8 Contractor Phone # 3- 6,,71 - q15 -1
Lic. Holder Name s City of Fort Collins License # 55" Supervisor Cert #
Mailing Address City
State Zip
LEGAL INFO:
Subdivision/PUD �� � Filing # Lot #� Block # �'3 Lot Sq Ft�,a7�
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) 11.51 Total Garage Sq Ft AIM
Residential Sq Ft 1151 Corl Sq Ft_ 0 #
1st Floor Sq Ft 474� 2M Floor Sq Ft TKO
# of Bedrooms a # of Full Baths
)f Stories �' / _� Bldg Height g � #Dwelling Units Q'hP.-
Unfinished Bsmt Sq Ft 6a 7 Finished Bsmt Sq Ft
'/A Baths _6r '/2 Baths I # 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 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # /%y List appropriate option #s 1146
UTILITIES INFO:
II
Water Tap Size ,3/`� Sewer Tap Size l Metere Ye or No �% Temp. Pedest�r No
Type of Heat: Ill Gas ❑ Electric Electric Main Breaker Size (Residential only): 150 Amp or Less
Value of Construction (including labor, material & profit) $ 14gQ, C9 9j .
p 1� _
Description of Work: t5/&44!J fi4�YI/�� u__314 (/� /Al_`_u
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
❑ 200 Amp ❑ Other
Electricalygo' 2y11 5-e-2CA�1Qaechanical /// uL (p�ll606 iy- 4244� PlumbbingL)ZM? �JV
Framer �i " � Roofing �/2i4� Concrete 4414,4 & &her
Applicant: I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with a I requirem nts
contained herein and City of FortAollins ordinances and state laws regulating building construction.
Applicant Signature/ 4-sa Y�i Print Name kjf9 (( ;!- E� Phone_-&b 3 ',59/'9/S%
Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE