HomeMy WebLinkAbout3656 Little Dipper Dr - Applications/Single Family New - 06/01/2007BUILDING PERMITS INSPECTIONS DIVISION
P.O. Box 580 •Fort Collins, COC80522-0580 • Phone: 221-6760
www.fcgov.com/building
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City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER���J / APPLICATION DATE v /
Job Site Address--5fW Unit #
PROPERTY OWNER INFO: (All owXer information is required -it is not optional) Phone #h_%�a—
Last Name pFirst Name p• Middle i
Street Address ���� �� y//F / 1 _� XJ/�I a CP City f�1SLL W&P9 StateoD Zip
CONTRACTOR INFO: Company Name r L C T41--" r Contractor Phone # / /to - O 7 `F' _i
Lic. Holder Name / A ! City of Fort Collins License #_ a -2 n Supervisor Cert #
Mailing
LEGALINFO: ( -6
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Subdivision/PUD / j Filing # Lot # Block #-0_ Lot Sq Ft %5, co
Total Building Sq Ft (not including basement) / �Co Total Garage Sq Ft5�
nn t
Residential Sq Ft `— Comm'I Sq Ft — # of Stories_ Bldg Height co- # Dwelling Units
-�)�
1st Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq Ft ` 9[) Finished Bsmt Sq Ft
# of Bedrooms oan^ # of Full Baths � 1/4 Baths '/2 Baths # of Fireplaces
Air Conditioning: es Ener : (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door r w/Blower D 5. Prescriptive w/Air Sling 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # List appropriate option #s
State Zip
CONSTRUCTION INFO:
UTILITIES INFO:
2 L411 Water Tap Size Sewer Tap Size Metered: es No Temp. Pedestal Yes r No
Type of Heat: ❑ Electric Electric Main Breaker Size (Residential only): "0 Amp or Less ❑ 200 Amp ❑ Other
Value of Constru tion (including labor, maternal & profit) $/ 10�; t �7 / L) . 71)
Description
Contact Name & Phone # of JOBSITE SUPERVISO
Subcontractor Info:
Electrical G�'c,ta �_ Mechanical =L6—x PlumbingFramer L Roofing �i(oncrete Other
Applicant: I hereby acknowledge that I ha v read this application and state that the above information is correct and agree to comply with all requirements
contained herei and Cty of Fort Collins or inane//and//st//ate laws regulating building ,c�o/nssttruuctiionn.
Applicant Sign `mil Print Namel "1/�"l Pho4
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE