HomeMy WebLinkAbout2620 Lodi Ct - Applications/Addition or Alteration - 10/19/2012BUILDING Pt &INSPECTIONS DIVISION
Q P.O. Box 580 •Fort Collins,hin CO 80522r0580 • Phone: 221-6760
www.fcgov.com/building
6City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER 1 u APPLICATION DATE lu/Ill(
Job Site Address alto goc,; 6— Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last Name�&-A ff2ik First Name kft-)- ,eC-N Middle
Street Address aWLD W; C4 City rM4 eni � I N -) StateCozip YOS-2
CONTRACTOR INFO: Company Name J�Mj gjp !S ReStntdL,P%DV Contractor Phone #
Lic. Holder Name !FPe& 5kAncc-VS City of Fort Collins License # Supervisor Certy�#
Mailing Address 1 OC6I N T' City Fot� nNk%!JS State CD zip zrb5a 4
LEGAL INFO:
Subdivision/PUD
Filing # Lot #
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft Comm] Sq
1s' Floor Sq Ft
# of Bedrooms
Air Conditioning: Yes
3. ResCheck w/Blower Door
2nd Floor Sq Ft
# of Full Baths
Block # Lot Sq
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft _
% Baths /2 Baths # of Fireplaces
No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
4. E-Star w/Blower Door 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
f LsQ-
Value of Construction (including labor, material &profit) $ S� O�Lti
Description of Work:ReA-ore A%-v-, hp T t-e In yea
Contact Name & Phone # of JOBSITE SUPERVISOR: a-22-2
Subcontractor Info:
Electrical Me rZkt-dijIC0-1 Mechanical Rat} 4PdVoU6 Fi4ir Plumbing aApkP, P1kn&WfVcf
Framer g % C, �r�t(�� .rJ_ Roofing �PigmA �5 R oncrete 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 City of f Cogigs ordinances and state laws regulating building construction.
Applicant Signatu Print Name 't-W 216taTs Phone
Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE