HomeMy WebLinkAbout1000 E Lincoln Ave - Applications/Reroof - 05/28/2013 (5)Fort Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416.2740
vvww fcgov corn/building
BUILDINQ PERMIT APPLICArI ON
APPLICATION NUMBER`�.J O W APPLICATION DATE 5 a j— j3
Job Site Address
Unit # %0
PROPERTY OWNER1 pINFO• (All owner Information la required — It is not optional) Phone # 9 I 0 - f Dt -7 I i
Last name !YI KMff.'-1 First Name Q Q _ Middle
n II��
Street Address olq� t /a � lfz_A h h r City Lf1S 'FtY1124.d 100 State Gtzip�%
CONTRACTOR INFO: Company Name Contractor Phone # 0,t - rO p
Lic Holder Name �C-�F --r�^ 1Q�C City of Fort
Collins License # Il ) Xh Supervisor Cert#_ t'1-319C]
Mailing Address 4��� Ill r1n n rpm tVe City d��Qt_ State CO Zip �b
SubdivisiordPUD L P4_ )6rA t j�t� Filing # �, 0 Lot # �" Block #ETC Lot Sq Ft '-fa
CONSTRUCTION INFO' Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height -# Dwelling Units
1" Floor Sq Ft 2A° Floor Sq Ft 31 Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths '/. Baths '/2 Baths # of Fireplaces
Air Conditioning: Ye,�]Noo Energy info: ( Circle appropriate choice) t. ComCheck 2. ResCheck w/Air Sealing 11
3. ResCheck w/Blower Door ❑4. Simulated Performance Alternative❑ 6. Prescriptive w/Air Sealing 11 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan # List appropriate option #s
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes []No[:] Temp. Pedestal Yes❑ No ❑
Type of Heat:11 Gas Electric Electric Main Breaker Size (Residential only) F-1150 Amp or Less ❑ 200 Amp Other
Value of Construction (including labor, material & profit) $
Description of Work. -
Contact Name & Phone # of JOBSITE SUPERVISOR:
Electrical
Framer
Roofing
Solar Other
Mechanical
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 of Fort Col ns ordinances and state laws regulating building constru Ion.
Applicant Signature Print Name h �T aij ,e�ne I t'_�3 CJJt•1CJ
Distribution: VVhfte- Office Yellow - Applicant Pink -VWWV/Stonnwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE