HomeMy WebLinkAbout4135 Verbena Way - Applications/Patio Cover Or Sun Shade - 09/10/2007T96-AAA S
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 1/ V L N// l;54 APPLICATION DATE / .01
Job Site Address 44-5S Qorzi3 r fA Lykf rUjaj Unit # tJA
PROPERTY OWNER
INFO: (All owner information is required - it is not optional) Phone # '!4*, -7 `2. 6086
Last Name,: �� L�� 6*et-�Pd e 9m/ gtj �Ouyi z. Middle COtreet Address f� _ fj�V& w� f(� �V City (l7M•i�G+V WIC) U ((� � 6tate �XJ Zip o 1—
CONTRACTOR INFO: Company Name
Lic. Holder N
Mailing Address_
LEGAL INFO:
Contractor Phone #
City of Fort Collins License # Supervisor Cart #
City_
State Zip
Subdivision/PUD Q(V-BO A 9L1L7V Filing # r Lot # ^ Block # ^ Lot Sq Ft Zo ow 4
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Z Total Garage Sq Ft 1.1A
Residential Sq Ft NA Comm'I Sq Ft'2-;4.9-_ # of Stories_ Bldg Height LQI # Dwelling Units NA
1st Floor Sq Ft 22S 2nd Floor Sq Ft NA Unfinished Bsmt Sq Ft NA Finished Bsmt Sq Ft NA
# of Bedrooms I # of Full Baths 1/4 Baths I '/z Baths — # of Fireplaces
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Energy info: (Circle appropriate choic) NA)PmCheck
4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing
List appropriate option
2. ResCheck w/Air Sealing
6. Prescriptive w/Blower Door
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal: Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only): ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit)
Description
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Roofing
Mechanical
Concrete
I19
Plumbing
Other
Applicant: I hereby acknowledge that I h ve ad this application and state that the above information is correct and agree to comply with all requirements
contained herein a d of Fort Co dins ces and state laws regulating building construction. r , / 2
Applicant Signatur e Print Nameyr lit i/i(L Phone �0 t t018. �y15
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE