HomeMy WebLinkAbout3906 Automation Way - Applications/Other - 06/12/2006BUILDING 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 (YV
��g � APPLICATION DATE
Job Site Address 3 2Vf /1141D- / 11 99/✓ "V Unit # /
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last Name K� IV G- First Name014 Vi j Middle
Street Address J!i3y /I&/TD/0�t?A/ 1--Fli a-&w. City fT, Ca/I��i� S O State 6 Zipg
/ �
CONTRACTOR INFO: Company Name ,( !,/TC e�7` 14,9 .f K1 Contractor Phone #
Lic. Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address_
LEGAL INFO:
Subdivision/PUD
City State.
Filing # Lot # Block #.
Total Building Sq Ft (not including basement)
Residential Sq t
1st Floor Sq Ft
# of Bedrooms
Air Conditioning: Yes No
Comm'I Sq Ft
2nd Floor Sq Ft
Zip
Lot S4 Ft
_
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
Unfinished Bsmt Sq Ft.
# of Full Baths % Baths '/2 Baths
Energy info: (Circle appropriate choice) 1. ComCheck
3. ResCheck w/Blower Door 4
City of Fort Collins Stock Plan #
UTILITIES INFO:
w/Blower Door 5. Prescriptive w/Air Sealing
List appropriate option #s,
Water Tap Size Sewer Tap Size
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker
Metered: Yes or No
Finished Bsmt Sq Ft
# of Fireplaces
2. ResCheck w/Air Sealing
6. Prescriptive w/Blower Door
Temp. Pedestal: Yes or No
only): ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of ` truction (including labor, material & profit) 0, a=
XDescriptionofWork: -3 Cy /gv oQwd 9A e6'9i1 Pelj
Contact Name & Phone # of JOBSITE SUPERVISOR:�/y
Subcontractor Info:
Electrical
Framer
Roofing
Mechanical
Concrete
Plumbing
Other
No
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 ort Collins grglipances and state laws regulating building construction.
Applicant Signature 4�2
Print Name Phon
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
___ THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE