HomeMy WebLinkAbout3709 Shallow Pond Dr - Applications/Single Family New - 03/08/2006BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER an APPLICATION DATE
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Job Site Address 3 -71)1 4,411ALi l�r�1� ' Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # y70— 2Z,6 -6 1,
Last Name ��iL��a �w,J First NameMiddle )j/4
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Street Address _,t Oq I)A// i / Te-41 City'(
ity }��T �r, /�j n1� State-66—zipo().5 ,e✓p
CONTRACTOR INFO: Company Name rc,,jIJe--j Contractor Phone # 7 —6-1&-023.3
Lic. Holder Name/ 1/ afJW-,'.i1 City of Fort Collins License # ) 7y4 Supervisor Cert #
Mailing Address i0 L3o�, 10:5:78 City �� L�t��%S State C7 zip 6 aZ
LEGAL INFO: n -
Subdivision/PUD:>��� �'.ake �/}NG� Filing # av= 11c Lot # Block # N,A L t Sq Ft Z
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) �i Total Garage Ft
Residential Sq Ft � Comm'I Sq Ft N It of Stories�Z Bldg Height # Dwelling Units
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1St Floor Sq Ft 3 r�', 2�d Floor Sq Ft Unfinished Bsmt Sq Ft / 34 !2 Anished Bsmt Sq Ft
# of Bedrooms # of Full Baths: 3/4 Baths Y2 Baths # of Fireplaces
Air Conditioning: Yes No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # List appropriate option #s
UTILITIES INFO:
Water Tap Size Sewer Tap Size _ Metered Yes or No Temp. Pedestal: Yes r No
Type of Heat: )<Gas ❑ Electric_ Electric Main Breaker Size (Residential only): ❑ 150 Amp or Less X200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ ZC2a /90 � Q
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR: — / `7 /" _S //)—
Subcontractor Info:
Electrical ��YG �!/t�G i Mechanical Plumbing/�ir/f�
Framer Gr/,-,tiy S ,� fing i4l ��it1 W� Concrete �� t /ti'► t, 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 of Fort Coll' s ordina es and state laws regulating building construction.
Applicant Signature Print Name's 9W- Phone % % 7
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Distribution: White — Office Yellow — Applicant ink — WWW/ water
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE
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