HomeMy WebLinkAbout619 Parliament Ct - Applications/Addition or Alteration - 12/19/2012City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
/ www.fcgov.com/building
}� BUILDING PERMIT APPLICATION
APPLICATION NUMBER /� �(APPLICATION DATE
Job Site Address b / `1 rt-y /,(w u r,,f L r— q 7U,1nit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # { <U 20y - 1013
Last name - e4/--- First Name ) Middle
Street Address 6 1 I I eil-'j4'y C- City, t r� 6f 1-5 State W Zip . -S
CONTRACTOR INFO: Company Name l od ii I Contractor Phone # 7c12 --�72-'AMA
Lic Holder Name �V�iI�'j� K /�Y�+ ' City of Fort Collins
/License # - 07 Supervisor Cert #
Mailing Address J >/ f/ lii,> �� City �f C�/1/�'�S State Zip
LEGAL INFO: ji/l
Subdivision/PUD &JI 4244 ' ' I �I S Filing # Lot # Block # Lot Sq Ft
ly CONSTRUCTION INFO: Total Building Sq Ft (not including basement) S� Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Z Bldg Height # Dwelling Units
1 s' Floor Sq Ft _ 16-id— 2nd Floor Sq Ft 3'd Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft ! -12 # of Bedrooms # of Full Baths % 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:
List appropriate option
11 h
Water Tap Size / Sewer Tap Size _/ Metere : es or
Type of Heat: 54Gas ❑ Electric Electric Main Breaker Size (Residential only)
Value of Construction (including labor, material & profit)
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR:
No Temp. Pedestal Yes or No
f 150 Amp or Less ❑ 200 Amp ❑ Other
Subcontractor Info:
Electrical 061-Z/w/.EeL l G Mechanical ;V9 / Plumbing N�
Framer C'?tS//o Roofing Concrete ^ i ST Fireplace
If V
Solar
Other
Other
Other
4�
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 li s rd' es and state laws regulating building construction. �( /
Applicant Signature Print Name I l6� lJ /� Phone 97dSa) T7
'/,/
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Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THUS APPLICATOON EXPURES 180 DAYS FROM APPLUCATOOM DATE