HomeMy WebLinkAbout4501 Boardwalk Dr - Applications/Deck - 08/22/2012City of
�F6rrt Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fegov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER � l V 1 LO
Job Site Address
APPLICATION DATE � I Q'4 11
Unit # I & q
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone # ' Z 3 ( 1 O
Last name :b q v t S First Name 0 o tv rtJ it Middle
Street Address 'ab0O �Afl 12 #%orv� o i2 City �7' C State d ZipZb5 LS
CONTRACTOR INFO: Company Name F'P l,'A' n o Contractor Phone # 5 q 1 5 .3 Z
Lic Holder Name 'S ry i6!q A SdrV City of Fort Collins License # Supervisor Cert #
Mailing Address t 5 LS &t09 f ti'r-/U Dip- City )a C State_0,0 Zip <Z5S 2 to
LEGAL INFO:
Subdivision/PUD
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
ls' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths % 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. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
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
OG
Value of Construction (including labor, material & profit)
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Mechanical
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowledge tha h be read thi pplication and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort C lin rdinan nd state laws regulating building construction.
G L
Applicant Signa Print Name 5 V VAt&) A SO ✓U Phone 3 (1 - 3 2
Distribution: White — Office Yellow— Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLOOATOON DATE