HomeMy WebLinkAbout2709 Canby Way - Applications/Basement Finish - 04/14/2006BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER V V APPLICATION DATE 7r�/ti/Ci(y
Job Site Address Z-709 CA&9aZ w�v Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #— q-?(D - $G7-331jk
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Last Name / � z' 1451-z- First Name :Z&A- V�I 5 Middle '61
Street Address 77 01 CA--j y b/ � City 6DzGirv5- State —(,a —Zip ,COS?-5
CONTRACTOR INFO: Company Name Contractor Phone #
Lic. Holder Name
Mailing Address
LEGAL INFO:
Subdivision/PUD
City of Fort Collins License #.
City
Filing # Lot #.
Total Building Sq Ft (not including basement)
Residential Sq Ft
1 st Floor Sq Ft
# of Bedrooms
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Supervisor Cert #
State Zip
Block # Lot Sq Ft.
Total Garage Sq Ft
Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
2nd Floor Sq Ft Unfinished Bsmt Sq Ft�Yinished Bsmt Sq Ft
f Full Baths % Baths 1/2Baths # of Fireplaces
E gy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
4. E-Star W�Rlower Door
5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
List appropriate option #s
Water Tap Size Sewer Tap Size 'Metered: Yes or No Temp. Pedestal: Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker SizX (Residential only): ❑ 150 Amp? Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ j. O G
Description of Work: 4 4: mie- o
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Roofing
Mechanical
Concrete
Plumbing
Other
Applicant: I hereby acknowledge that I have read this appli ion and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort C ordina state ws regulating building construction. J.
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Applicant Signature Print Name 'ZL�/%�/!.-, Phone
Distri tion: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE