HomeMy WebLinkAbout2139 Nancy Gray Ave - Applications/Single Family New - 03/30/2007BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
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Citv of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER 1 �— [ APPLICATION DATE 3
Job Site Address
Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # S,!5)-3
Last Name d/ ?11 First Name Middle
Street Address-2l'/ % 6�l�J/ ` /�• _.Yfe • �09 City � ��- State LSD Zip D
CONTRACTOR INFO: Company Name Selma//pi/ 9:iw, , L •L C Contractor PPhone # .303- S9/- q/S/
Lic. Holder Name, /_Acii t/% City of Fort Collins License # // -SSA` Supervisor Cert #
Mailing Address, &go &'60 w- City State Zip
LEGAL INFO:
Subdivision/PUD Filing #_ Lot #_ Block # o� _Lot Sq Ft a %�
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) A2 ffs Total Garage Sq Ft
Residential Sq Ft j Comm'I Sq Ft_4001_ # of Stories Bldg Height # Dwelling Units 6A_e�
1st Floor Sq Ft 6!i8' 2nd Floor Sq Ft / 3.7 Unfinished Bsmt Sq Ft 5 Sa., Finished Bsmt Sq Ft 0
# of Bedrooms ,3 # of Full Baths 12. Y4 Baths ( % Baths _ I # of Fireplaces
Air Conditioning: Yes Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door E-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # / 2Ud List appropriate option #s
UTILITIES INFO:
01
Water Tap Size Sewer Tap Size .91 Meteredzipor No Temp. Pedestal or No
Type of Heat: ®'Gas ❑ Electric Electric Main Breaker Size (Residential only): 111'50 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & prof�it�)/$ ,✓��UY • 2
Description of Work: OZ1114il i &NA 2ZR � �IGGP�
8 2 2�;:? 033 5C) 05
Contact Name & Phone # of JOBSITE SUPERVISOR: /PALtU A-e-116 J�0.3 - 5ql - 915
Subcontractor Info: p�
Electrical ��ll C'/�yyS/B91 c��UIG� 6�6& • Mechanical ee&,ZWd nh), �u Plumbing J2,eeP CyGO/
Framer L' -C dl'D Roofing 71,9. )&fl1'9 Concrete /g_A heC50'���/�yD�y
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 o ort Collins ordinances and state laws regulating building construction.
Applicant Signature Print Name ;e Phone
Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE