HomeMy WebLinkAbout3450 Lost Lake Pl - Applications/Basement Finish - 07/03/2013COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. - Fort Collins, CO 80522-0580 - Phone: 970.221-6760
www.fcaov.com/building
101 Lk 5,3
BUILDING PERMIT APPLICATION
APPLICATION NUMBER APPLICATION DATE v
Job Site Address 3 q-4'b Lo5l- Unit # (�
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # i7o — 6�����
Last name Cam' omM Ids First Name Middle
Street Address J7 Jed P{/ , City I��21141:g Stat
CONTRACTOR INFO: o)/mpaanny Name G Contractor Phone # 970- 64�3-0 310
Lic Holder Name al �(d An- Jla City of Fort Collins License # j Supervisor Cert #C'
Mailing Address 73 Q Tejo IL )U, City / State r,6 • Zip &43--R)
LEGAL INFO:
Subdivision/PUDj 1 Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including be
Residential Sq Ft
1s' Floor Sq Ft
Comm'] Sq
2nd Floor Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths — % Baths —/— % Baths — # of Fireplaces
Air Conditioning: Yes No Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
List appropriate option #s
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: AJ Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, -material & profit) $,Z/) Q�7 L 3 3
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer Roofing —
Solar
Mechanical
C ncrete
Other Other
Fireplace
Other
Applicant: I hereby acknowledge hat I have read this plication and state that the above information is correct and agree to comply with all requirements
contained herein and City oj.Fo C lins ordinances state laws regulating building 771
ction.Applicant Signature Print NamePhone
Distribution: White — Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATIOM EXPIRES 180 DAYS FROM APPLICATION DATE