HomeMy WebLinkAbout3727 Full Moon Dr - Applications/Single Family New - 05/08/2006BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER_ ftka I I APPLICATION DATE II V 1
Job Site Address 2JgZ--+ -Rut Kt-oon`= Unit # PROPERTY O/ WNER INFO: (All o�CZwn�er/iinformation is required - it is not optional) Phone #r� �_ - I-7
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Last Name (-LLa4C:.l UJ r First Name Middle
Street Address City k= t v,`ryV ► Statel,-b Zi�&07DJ
CONTRACTOR INFO: Company Name LUac2- j�� � Contractor Phone # Gad
Lic. Holder Name City of Fort Collins License # d I Supervisor Cert #
Mailing Address
City
State . Zip
LEGAL INFO:
Subdivision/PUD �(�1 .( 1����- Filing # Lot # Block # Lot Sq Ft C�-�
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) �j �� Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories_ Bldg Height �� 1 # Dwelling Units 1
1st Floor Sq Ft C 2nd Floor Sq Ft Unfinished Bsmt Sq Ft b(OS Finished Bsmt Sq Ft
# of Bedrooms / # of Full Baths 2% Baths 1/2Baths // # of Fireplaces (I�
Air Conditioning: Ye'y No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door . E-Star /Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
List appropriate option #s
City of Fort Collins Stock Plan #
UTILITIES INFO:
�-) I ..� k
Water Tap Size Sewer Tap Size Metered: es or No Temp. Pedestal: Gor 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
Contact Name & Phone # of JOBSITE SUPERVISOR:
Oplumbing L�
ConcretePj Y14 � �, 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 Cit of Fort Collins ordinanc s and state laws regulating building construction.
Applicant Signaturi9.J'I Print Name �\X(t Xl0_ Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE