HomeMy WebLinkAbout620 Gilgalad Way - Applications/Deck - 07/03/2013City 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 f2l' / O ✓ / 1 I APPLICATION DATE
Job Site Address (oZo �^ < A-t&j> ICJ Unit #
PROPERTY OWNER INFO: (All owner information is required - it is
Last name 'fib 11�Cr+��LO � First Name
Street Address (aW . (r , IC ,V (A-0 IJ h-f/
CONTRACTOR INFO: Company Name L-1-eA) 1J'4N 44
not optional) Phone #.
u
City
Middle
State CC Zip
r Phone # 303 - 817 -g1 Y9
Lic Holder Name �9 City of Fort Collins License # Supervisor Curt ,#
Mailing Address Z �" City G wit State Zip Z�DS__0
LEGAL INFO:
Subdivision/PUD Filing #J` Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) otal Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
111 Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % 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:
Water Tap Size Sewer Tap Size
List appropriate option #s
Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) L34,,50 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction(including labor, material & rofit 0(
Descri�ort of Wor
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ll C..
Contact Name & Phone # of JOBSITE SUPERVISOR: `: �`���✓t� ' D 67 "D 1 Y 7
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby ackn t I have read this application and state that the above information is correct and agree to comply with all requirements
contained herein a i rt Colli s orC
cesand state laws regulating buildin truction. Q ,I� �[f� �Q
Applicant Signature Print Name a NC'C �-C k) . Phone i'V -6; A_ {
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE