HomeMy WebLinkAbout5100 Northern Lights Dr - Applications/Duplex - 09/06/2012COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
APPLICATION
Job Site Address 5 )0 0
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
) 02Z
BUILDING PERMIT APPLICATION
o..�
APPLICATION
T- Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #_
Last name P,<>t9P�Zi First Name Middle
Street Address30n Q��+'—"rind -+1 )D3 City 601-CIr3 State �e Zip
q �
CONTRACTOR INFO: Company Name �� � Cs�nl��L�c �l.,1.1, (Contractor Phone#
Lic Holder Name J( 170 (o't/'V:t City of Fort Collins License # Supervisor Cert #
Mailing Address pq?'ZZ�4c�' Cit ILI State Zip 5
LEGAL INFO:
Subdivision/PUD' tit-) izt. � fz' r%�ks Filing # I Lot # J� Block # � Lot Sq Ft 2 1t d o a
CONSTRUCTION INFO- Total Building Sq Ft (not including basement) ?jTT% �7 d Total Garage Sq Ft
`r Residential Sq Ft13 Comm'I Sq Ft �� # of Stories Bldg Height (� # Dwelling Units
�r-
15t Floor Sq Ft 2nd Floor Sq Ft 3" Floor Sq Ft Unfiished Bsmt Sq Ft
rrl S
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths 3/< Baths i '/2 Baths # of Fireplaces
Air Conditioning:: No Energy info: ( Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Do 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan # . CL�4ue I-oy') List appropriate option #si �" �I "/T t C 9
UTILITIES INFO:
ti
Water Tap Size 311 Sewer Tap Size + Meteredz!5�br No Temp. Pedesta�or No
Type of Heat: Gas ❑ Electric Electric Main Breaker Size (Residential only) X50 Amp or Less ❑'21000 Amp El Other
Value of Construction (including labor, material & profit) $ Z"L b _ y I'1 41 _ G 0
Description of Work:
S�
Contact Name & Phone # of JOBSITE SUPERVISOR: SDN-,/) �V O VT 5 C t -� 0 / T
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical 1 r-1
Concrete
Other
Plumbing Pt`Yd7- I LLtv-13,� j
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 of Fort Collins ordinances and state llaws srregulating building construction.
Applicant Signature�-n Print Name r>/�Sy) J 0auTS Phonee57o)22�-�535
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THUS APPLICATION EXPURES 180 DAYS FROM APPLICATION ®ATE