HomeMy WebLinkAbout4915 Fossil Blvd - Applications/New Commercial - 06/21/2012 (2)City of
II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER_ D APPLICATION DATE
Job Site Address 4 9 � 5 Vo SS t `mil cl. Unit #
PROPERTY OWNER INFO: (All owner information is required — it is not optional) PhoneT
lI # 1-! J �� ^^ To "—` — c3z� `� V
Last name c ``\ C 'E �/ 1 First Name V—s C'" V\ Ck CI Middle T� ,
Street Address � cjG � 0.� (1 �^F E h\� e - City_ J n v -t l � t v� J State C: � Zip r
CONTRACTOR INFO: Company Name -V G) b Contractor Phone #
Lic Holder Name
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City of Fort Collins License #
Supervisor CeCrtt #
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Mailing Address 1" • lJ
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City �,n , (Lo d State
CC Zip C,Q 7Z Z
LEGAL INFO: { \.
Subdivision/PUID �0 ��1 A it a VIA � 1 CC'vli' iling # Lot # Block # Lot Sq Ft_
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) 4 _j 4 Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft �� # of Stories Bldg Height I t I g g �� #Dwelling Units
151 Floor Sq Ft 20d Floor Sq Ft _ 3`d Floor Sq Ft �— Unfiished Bsmt Sq Ft �
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths -- 3/4 Baths -- '/2 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
I 1 L%
Water Tap Size — Sewer Tap Size Metered Yes or
Type of Heat: XGas ❑ Electric Electric Main Breaker Size (Residential only)
No Temp. Pedestal Yes or No
Value of Construction (including labor, material & profit) $ C
Description of Work: C ® V-%s A- v
❑ 150 Amp or Less ❑ 200 Amp ❑ Other
S (i5 P -4-
Contact Name & Phone #}_of JOBSITE SUPERVISOR: T WL)
Subcontractor Info: I FJ D F Q S- A ti �✓' �J v k e\^ 2 zH - w l
Electrical
Framer
Solar
Roofing
Other
Mechanical melon t✓ Plumbing
— CCooncrete / �1] `� ' Fireplace
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 Ciit�=�f�lFort Collins ordina ces and state laws regulating building construction.. V' `
Applicant Signature 1� t , Q � Print Name NO \- '2 cjA ev Phone ft77-6— 22- ('-{_,80:
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
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