HomeMy WebLinkAbout2668 Thoreau Dr - Applications/Single Family New - 03/12/2007BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 •Fort Collins, CO 50522r0580 • Phone: 221-6760
www.fcgov.com/building
City of Fort Collins BUILDING PERMIT APPLICATION
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APPLICATION NUMBER L
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APPLICATION DATE
Job Site Address 21, /Unit #
Phone #( �%) --530 -51-1Po
PROPERTY OWNER INFO: (All owner information is required - it is not optional)
Last Name C First Name
Middle
Street Address ). 7aw �G� #� 1) City 0)%7 ZLCIi State Co zip Q�3
CONTRACTOR INFO: Company Name /Tj/�itG /IY� o/J i Contractor Phone
Lic. Holder Name &II)y r..f %Z.f [ .4EIz , City of Fort Collins License # b-574 Supervisor Cart #,,,2j�le)
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Mailing Address % L / Id '� �� ���y°�� City C State ('0 zip
LEGALINFO:
Subdivision/PUD 1 ' l-aa(, l LQ Filing # Lot # Block # Jr Lot Sq Ft lri Jln�
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) 19, (n Total Garage Sq Ft /j(y
Residential Sq Ft 1%-e,) Comml Sq Ft — # of Stories Bldg Height , # Dwelling Units I
1st Floor Sq Ft 2nd Floor Sq Ft 666 Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft —
# of Bedrooms 3 # of Full Baths 1--� '/< Baths a /2 Baths # of Fireplaces
Air Conditioning: Yes No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door OE -Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # 1751 List appropriate option #s
UTILITIES INFO:
Water Tap Size 31y ,. Sewer Tap Size Y /I Metered: es- or No Temp. Pedestal: Yes or No
Type of Heat: KGas ❑ Electric Electric Main Breaker Size (Residential only): )K 150 Amp or Less 11200 Amp ❑ Other
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Value of Construction (including labor, material & profit)
Description of Work:
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Contact Name & Phone # of JOBSITE SUPERVISOR: Lhlb) ;La `ZO
Subcontractor Info: j� t
Electrical�,/i (" UL�! . Mechanical �/n5 lZ�/h n ry-1 Plumbing �Lgl
Framer ? A Roofing f_ d )yy,do-,,,i,o Concrete _ (Q -L� Pther
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 ordinances and state laws regulating building construction.
Applicant Signature (a _'1 14 LlCGlG1.C�], Print Name�Le��[V�tiS iq PhoneJ�—%��,
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE