HomeMy WebLinkAbout6570 Portner Rd - Applications/Addition or Alteration - 10/04/2013City of
/11�F,�ort Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER %) )c, &I 2 APPLICATION DATE 1".0 t I
Job Site Address G -7Q 3 o4j j, -2!c �G L(� Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # ` -70 - -2--Z' i - (,:93�!,
Last name Q c'P;tJA Cot �brt. First Name Middle
Street Address 0 LCE;P fJ6 e, ^� CitState CO Zip
CONTRACTOR INFO: Company Namee��� Y�41rt^>t _ Contractor Phone # 12n - 6&6 -Zo3S'
Lic Holder Name 2.!✓�rwL1L�,y rv`� City of Fort Collins License # E ' L Supervisor Cart #
Mailing Address ) ��j oyCe- aV C - City �o r� �� �I KS State L O Zip �oZi
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq
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
11 Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths /s 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
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 ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ ;Z OD
11 �
Description of Work d
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vVl Al.l. O 1� f V k AA t10-s ! LLNL d u P i Vl."t'
Contact Name & Phone # of JOBSITE SUPERVISOR: i (1 Pi l W t t/�.� — �5 (o (o - —/0 `TLs--
Subcontractor Info:
1 r�ruL Electrical) U07jPf�W��L 'CfMechanical
Framer I - 'K Roofing
Solar
Other
Concrete
Other
Plumbing
Fireplace
Other
Emil
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 and state laws regulating building construction.
Applicant Signature Print Name T , y Phone
It
Distribution: Qite - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE