HomeMy WebLinkAbout6357 Carmichael St - Applications/Deck - 11/16/2012City of II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
�t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fegov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER O�� �LrL APPLICATION DATE
Job Site Add
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone #
Last
Stree
CONTRACTOR INFO: Company Name
Lic Holder Name
Unit #
Contractor Phone #
City of Fort Collins License #_
Mailing Address City
LEGAL INFO:
Subdivision/PUD Filing #_
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)_
Residential Sq Ft Comm'I Sq
1s' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
# of Bedrooms
a
State_C_�Q_Zip—�
Supervisor Cert #.
State Zip
Lot # Block # Lot Sq Ft
Total Garage Sq Ft
_ # of Stories Bldg Height # Dwelling Units _
31d Floor Sq Ft Unfiished Bsmt Sq Ft _
# of Full Baths Y4 Baths '/z 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:
Water Tap Size Sewer Tap Size
List appropriate option
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) $ i J� � I1� ,^
Description of Work: C'�NS IlY"c+ Q �(� t )( �f�I CC PCk Q f I)Q CjC C)-� t \ CtUS Q
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Mechanical
Roofing Concrete
Other Other
Plumbing
Fireplace
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 Collin n finances and state Taws regulating building construction.
Applicant Signature Print Name /% ?A 7 1 YY*I / t2 nFGY)Phone j:&J-1191,11
Distribution: White — Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE