HomeMy WebLinkAbout2263 Clearfield Way - Applications/Single Family New - 07/03/2007BUILDING PERMITS & INSPECTIONS DIVISION
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
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APPLICATION DATE J
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Job Site Address
&pd a Unit #
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PROPERTY OWNER INFO: (All owner information is required - it it/
s nott do I) Phone #_yT.Zo /- 7(7 Ib
Last Name Fit -Name 4.42 AX%o Middle
Street Address City L�uf State Zip 30S
CONTRACTOR INFO: CompannyNameld4i;&M S' 41� 0ontractor Phone #qTo _1V_96Q6 B�-
Lic. Holder Name G �T�j���,�o City of Fort C !' s Li nse # / Supervisor Cart #�y,�`Axi
Mailing Addresst� J / o -74-P -� City State Zip �S
LEGAL INFO:
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Subdivision/PUD Filing #� Lot #� Block #. OC7 Lot Sq Ft G 38 3 rr-
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CONSTRUCTION INFO: Total Building Sq Ft (not including basement) /�/%� Total Garage Sq Ft %� \
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Residential Sq Ft 7Z Comm'I Sq Ft -'� # of Stories_ Bldg Height(2S # Dwelling Units 1
1st Floor Sq Ft 68-Z3 2nd Floor Sq Ft ?33 Unfinished Bsmt Sq Ft(::;a?7_ Finished Bsmt Sq Ft b
# of Bedrooms V # of Full Baths 3K Baths '/ Baths # of Fireplaces �1 )
Air Conditioning: Yes GD Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing `fir
3. ResCheck w/Blower Door Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door Yi
City of Fort Collins Stock Plan # List appropriate option #s
UTILITIES INFO: CL[ Co, �Ka der�
Water Tap Size �r Sewer Tap Size Al fr Metere es r No Temp. Pedesta<�r No
Type of Heat: ®-t as ❑ Electric Electric Main Breaker Size (Residential only): 0<5-0 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ /4O . / 6,5
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Contact Name & Phone # of JOBSITE SUPERVISOR: Q4nd (" /9'Z2
Subcontractor Inf
Electrical t 8. Mechanical (1e ff dr /0, Plumbing 1�-V�r-
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Framek S �.SL�oofing ! �TConcrete _4v46L( Bother
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 rt Collins or ces and state laws regulating building construction.
<m.� 567--S33a Applicant Signature i Print Name J:[t< Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE