HomeMy WebLinkAbout5198 Conejos Rd - Applications/Other - 02/07/20086a
City of Fort Collins
APPLICATION NUM
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
3d�— APPI ICATION I
,! /(9
Job Site Address tr t1%i (Q 1 V01 W UVit #
r
PROPERTY OWNER INFO: (All owner information is reecared - it is not optional) Phone # CZ�
Last Name ��t4L- -) iFirst Name Middle
Street Address,_G . RV ' <<4 l4Z City State Zip
,ply �_/
CONTRACTOR INFO: Company N mee 1 j� ( (contractor Phone # � 0 Q�(�' �Y / Vim)
Lic. Holder Name I _ City of Fort�C-ollins License t Supervisor Cert #
Mailing AddressFr t City t' t �i{iWl. State Zip
LEGAL INFO:
Subdivision/PUD
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm] Sq Ft # of Stories Bldg Height # Dwelling Units
1st Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft _
# of Bedrooms # of Full Baths % Baths '/2 Baths # of Fireplaces
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
List appropriate option
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 of Work:,
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Roofing
Mechanical
Plumbing
Concretet -�D 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 o Fort Collins ordinances and state laws regulating building construction.
Applicant Signature Print Name, Phone
Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE