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City of Fort Collins
MENOMONEE
BUILDING PERMITS & INSPECTIONS DIVISION
E0. Box 580 • Fart Collins, CO 8052MSSO • Phone: 221-&60
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER /� () v V lJ �L /) APPLICATION DATE 3 �C`
Job SlteAddress 115� &lAr26/u AJ6 F/LIJL I!/E Unit# 11114
PROPERTY OWNER IN(Ali owner Information Is required - It Is -not optional) Phone 0 3V3 -
Last Name / CQG{ N� First Name / �h✓�`/� MiddleL—
Street Address % W // 1/C city- I kfS V a%57b2 state Lo. zip
CONTRACTOR INFO: Company Name SNf7V4J - el Y I Contractor phone * ?ZD- 3kr-)(-1333 _
Uc. Holder Name City of Fort Collins License # Supervisor Cart #
Mailing Address IZOva -ZV0UI ST. r Su ITS 14 City state Go zip OOZ-3+
1 aaer INF( 2
Subdvlsion/PUD 467AJ,66 Filing 0 J Lot p 3 Block 0 Lot Sq Ft// 7� 3
CONSTRUCTION INFO: Total Building Sq Ft Ina IncludNg beeanent) W-5 Total Garage Sq Ft
Residential Sq Ft J&Z Comm'I Sq Ft N /� 1! of Stories Bldg Height Z`j! 33/4N# Dwelling Unite I
19 Floor Sq Ft 1 (0�J 2n^ Floor Sq Ft N Unfinished Bamt Sq Ft O 3 Flnlshsd Band Sq Ft AJA
# of Bedrooms Z t 0 of Full Baths Z % Baths PU/a- Y, Baths /t1 A # of Fireplaces
Air CondiMnlnp: Yea No Energy firo: (Chwo appmprlab obobe) 1. ComCheck 2- RssChsck WAY Sealing
3. ReaCheck w/Blower Door 4. Ear w/Blower Door 5. Prescriptive w/Air healing 8. Prescriptive w0cwer Door
1703 I �Z. 3'
City of Fort Collins Stock Plan • List appropriate option,fta Fvcl, &A(TT-, �t/QETLAfb� es,� ll)Ia&o /.t) R1,%T6,e
UTILITIES [NF0:
Water Tap Size Bawer Tap Size Metered: Q or No Temp. Pedestal: (& or No \
Type of Heat Q/G sa O Electric Electric Main Breaker Slur (Residential only): 13116OAmp or Leas O 20OAmp Mother
Value of Construction (Including labor, material 6 pmflt) i f9
DesolplionofWork: NSA aWiLYl�
Contact Name 6 Phone *of JOBSITE SUPERVISOR: �l KE ATE/it/MET� 3Z0-:�v1-1333
SuboontraatorInto,
Electrical EDS �GeCfRIG Mechanical T0V� �I Plumbing dT%r j A11 .�J
Framer �kft /',oA)bT RoMing AVL � /1iy Concrete yY 4 oaeF- Other
Applicant I hereby acknowledge tiro I have read this application and state that the above Information Is correct and agree to comply with all requirements
contained heroin and G ColNns ordinances and elate laws regulating building construction.
Applicant Signature/ffl�r Print Name /0� lef e- _ Phone 3C3-+7Z-135L
Distribution: While-01111co Yellow -Applicant Pink - WWW/Swrrywater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE