HomeMy WebLinkAbout2639 Thoreau Dr - Applications/Single Family New - 04/12/2007BUILDING PERMITS & INSPECTIONSDIVISION
P.O. Box 580 •Fort Collins, CO 80522^05800580 - Phone: 221-6760
,a www.fcgov.coxn/building
CityofFort Collins BUILDING PERMIT APPLICATION
/2-O-7-
APPLICATION NUMBER O APPLICATION DATE
Job Site Address T�RUnit #
PROPERTY OWNER INFO: (All owner inform to is required - it is not optional) Phoney-{
Last Name F t Name Middle (`
Street Address Cit Nate \ Zi
CONTRACTOR INFO: Comparly Na_ Contractor hone C V
Lic. Holder Na
Mailing
of Fo ,Collins Lic nse Supervisor Cert #
Cit - State Zip
LEGALINFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) I Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories_ Bldg Height # Dwelling Units
1st Floor Sq Ft 1Z_ 2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Bedrooms # of. Full Baths _ 3/4 Baths t_ '/2 Baths r # of Fireplaces
Air Conditioning Ye 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 # 1� List appropriate option #s
UTILITIES INFO:
Water Tap Size - Sewer Tap Size Metered o Yes r No Temp. Pedestal: Yes or No
Type of Heat: AGas ❑ Electric Electric Main Breaker Size (Residential only): � 150 Amp or Less ❑ 00 Amp ❑ Other
Value of Construction (including labor, material & profit)
Description of Work:
I
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor I fo:
AP I,r /�
Electrical r 1 , �� �. 1 l Mechanical _ I l_ ,� I iPlumbingg �
Framer
Roofing
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 CiI of Fort�Cg%lli rdinances and state laws regulating building construction. 1
Applicant Signature (0, I L (- 0 1, Print Nam C Phone 1�
Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE