HomeMy WebLinkAbout2510 W Elizabeth St - Applications/Accessory or Secondary Building - 06/23/2006BUILDING PERMITS &INSPECTIONS DIVISION
Phone:
P.O. Box 580 •Fort Collins, CO 80522-0580 • Phone: 221-61-6
760
www.fcgov.com/building
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER 0 APPLICATION DATE
Job Site Address L.S/p Lv �1/z
S' Unit #
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone # j%
Last Name !7 1 Se_141'',104 ,-1 First Name 1--B4 t4 k)e Middle c/
Street Address A 6� /0 "% p/ 1 k— h$fih City % C O 111A1 9 State <U Zip
CONTRACTOR INFO: Company Name 77&¢ Contractor Phone #
Lic. Holder Name City of Fort Collins License # Supervisor Cent #
Mailing Add
LEGAL INFO:
Subdivision/PUD
City
State
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft cc V `
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units O
1st Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Bedrooms # of Full Baths '/4 Baths /2 Baths # of Fireplaces
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing m
4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
List appropriate option #s V )
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal: Yes or 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 Work: y i
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Mechanical
Plumbing
Framer Roofing Concrete Otth7her 7
Applicant: I hereby acknowledge that I have read this application and state that the above informati rr agree te���nr�(ly eq
contained herein and City of Fort Collins ordinances and state laws regulating building construction. 3 —
Applicant Signature • �Print Namei"n v t7. ///I SCI ne 9�& y72G�S�/
Distribution: White — Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE