HomeMy WebLinkAbout2638 Thoreau Dr - Applications/Single Family New - 04/23/2007BUILDING PERMITS & INSPECTIONS DIVISION
f P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER `� APPLICATION DATE 07
Job Site Address ,1?J-Aar) _. & - Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional)
Last Name(:::�nI M A,14 '�Y()7�� 5, First Name
Phone # r!�j �b) _� i''J=t(go
Middle
Street Address 15/� (Jr �Q ,Y (Yi CityStatezip 4934
CONTRACTOR INFO: Company Name �I747,14 Contractor Phone # (C;Q3 �(>
Lic. Holder Name L( J�Ma r�1�9 City of Fort Collins License #��/�� Supervisor Cert #
Mailing Address�i� /Z2420"-34' �Cl: City ''d State(.90 zip V�o3V
LEGAL INFO: C /�
Subdivision/PUD (' /C.�((�� Filing # Lot #_ Block # J Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) s 3l %S Total Garage Sq Ft "U33
Residential Sq Ft 130S Comm'I Sq Ft # of Stories Bldg Height O ' # Dwelling Units
1st Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq Ft �.�/')�; ` Finished Bsmt Sq Ft
# of Bedrooms # of. Full Baths % Baths 1/2Baths - # of Fireplaces =
Air Conditioning: Yes No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door (VE-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # / 2447 List appropriate option #s
UTILITIES INFO:
Water Tap Size !{ „ Sewer Tap Size 41 Metered: Yes or No Temp. Pedestal: Yes or No
Type of Heat: XGas ❑ Electric Electric Main Breaker Size (Residential only): &'l50 Amp or Less ❑ 200 Amp ❑ Other
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Value of Construction (including labor, material & profit) $ zal,, %-a'- � 3se) I,�G'-
Description
Contact Name & Phone # of JOBSITE SUPERVISOR: A JC'US(7 J/.1 Y)" i n if /\ C % /L) ) :�) _-C % --
Subcontractor Info: Y� / !�
Electricals (�i �'ei X-PGZ�iCc� Mechanical A.`5 �y0/i�i�vy-&(CPlumbing 7-Ah
Framer �QD Roofing..&&,Concrete(lad-l--/, Oee Other
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 Print Name Phone .3.3,0 54k)
Distribution: White — Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE