HomeMy WebLinkAbout2314 Nancy Gray Ave - Applications/Basement Finish - 08/29/2012i
City of
Fort Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER ?D I `052' APPLICATION DATE L]IQPI \C��
Job Site Address �'�\y �1CC_�I �Cc2�l 1��14 CIU�_ Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # (C\--'& i Ln J
Last name�(]\T\C c�iC\\ \ 1� 1 tJU�dril�jFiirrs_t Name
. Middle
j(y�
Street Address ` cityy\-. ���\\n�� / State
Zip i
CONTRACTOR INFO: Company Name t�QLT,c1g(�\\ti��C��S Contractor Phone #
Lic Holder Name 41C A City of Fort Collins License N� r Supervisor Cert #
Mailing Add
City
LEGAL INFO:
Subdivision/PUD S�\ Filing #,
State
Lot # "1 Block # Lot Sq Ft' -Alta
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm] Sq
# of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft 2nd Floor Sq Ft 31d Floor Sq Ft
�$
Finished Bsmt Sq Ft, cl# of Bedrooms �_ # of Full Baths '/< Baths
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Unfiished Bsmt Sq Ft "&AX
'/z Baths # of Fireplaces
Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
List appropriate option
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) $7&--A ��yO
litescription of Work: K�
Contact Name & Phone # of JOBSITE SUPERVISOR: Cxy V d / \A\ ci-\-\&�:\P\
Subcontractor Info:
Electrical _ ' C Mechanical�\ Plumbing
Framer n(' ,\Q3:-_ Roofing Concrete Fireplace
Solar
Other
Other
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 or finances and state laws regulating building construction.
Applicant Signature Print Name r `: r\ i c�f�C1 Phone Qr -
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE