HomeMy WebLinkAbout1041 W Vine Dr - Applications/Addition or Alteration - 01/24/2008BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER �Il ��0 U`' 1 / APPLICATION DATE
Job Site Address f l L� �/�AL� Unlit # T,t
PROPERTY ER INFO: (All olw�n-errinformation is required - it is not optional) Phone # [ 70 -f 30 -3 3
Last Name First 1 First Name < < L— Middle
Street Address f DgfZ,S State CO Zip.S L r
CONTRACTOR INFO: Company Name - t�j7^�` actor Phone # 70 Z!8 �33 2 L�
Lic. Holder Name City of Fort Colli s License #�37 Supervisor Cert #
Mailing Address /�� .� City State Zip ev-60�st�D
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft Comm'I Sq
1st Floor Sq Ft
2nd Floor Sq Ft
# of Bedrooms # of Full Baths
Air Conditioning:. Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
_ Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft _
% Baths X2 Baths # of Fireplaces
Energy info: (Circle appropriate choice) 1. ComCheck
4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing
List appropriate option #s
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 Co
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical Mechanical Plumbing
Framer Roofing Concrete Other
Applicant: I hereby acknowledge have rea this application and state that the above informatio correct and agree to comply with all requirements
contained herein and ort o s ordinance and state laws regulating building constructio
Applicant Signatu Print Name hone
`I7bZ/ ,3 3l�U
istribution: it'
Yellow— Applicant Pink — WWW/Stormwater
THIS ATION E ES 90 DAYS FROM APPLICATION DATE