HomeMy WebLinkAbout2151 Chesapeake Dr - Applications/Basement Finish - 07/25/2013City of
II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
FOI t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 - Phone: 970-221-6760
/ www.fcggv.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER a l 1 �) n :5 2 "Oa APPLICATION DATE �/ v
Job Site Address Unit #
PROPERTY OWNER INFO:
(All owner information is required - it is n/
not optional) Phone # '7 70 /2 Z %— 59¢1
Last name First Name Middle L
Street Address Z%.S b?- City )*FiI- Gf/LL/.ys State Ll/ Zip
Company Name
Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cart #
Mailing Address City State Zip
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'I Sq
15' Floor Sq Ft
Finished Bsmt Sq Ft
21 Floor Sq Ft
Filing # Lot # Block # Lot Sq Ft
ement) Total Garage Sq Ft
_ # of Stories Bldg Height # Dwelling Units
3'd Floor Sq Ft
# of Bedrooms # of Full Baths '/4 Baths
Unfiished Bsmt Sq Ft _
/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 #s
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 2:^100 A/m�p ❑ O'11thher
Value of Construction (including labor, material & profit) $ ��Z/� �U j- Y
Description^o_f�: i-1WJ5;;q o�✓�� tet L Ab� �l D►-�/C� �4111
iiZ
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
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 Collins ordinances rid state laws regulating building construction. Applicant Signature--� Print Name ),. WAk-< -,?A Phone
Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE