HomeMy WebLinkAbout5232 Southern Cross Ln - Applications/Basement Finish - 01/15/2014City of I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
�t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 151 ybo tad APPLICATION DATE ! /- 15-//L,
Job Site Address
Unit #
PROPERTY OjWNER INFO: (All owner information is required - It' not optional) Phone #
Last name_ ( 1 K & 13 E First Name 6?h0�6Do1�� Middle
Street Address c-3Z-- 4,0VTm ER N 20 s s,14PECity IUD Rt loa-t N S State Gd-) Zip � C�?- 9
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address_
LEGALINFO:
Subdivision/PUD
Contractor Phone
City of Fort Collins License # Supervisor Cert #.
State Zip
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
1s' Floor Sq Ft
2nd Floor Sq Ft
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft 6410 # 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
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) $ 1;6�1 -7
Description of Work: �lN►S/�//Vl¢sE.yEI�� % tit/ '� Y/(ZfjO/V(s, ji '�h HRaGjI�
S; t t?h-G, E &=AA _ t
Contact Name & Phone # of JOBSITE SUPERVISOR: T-AN p0 iJ 61 2—E' 11 L. 1 %D • S Ql- - ^kN\
Subcontractor Info:
Electrical
Framer
Solar
Mechanical
Roofing Concrete
Other
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowl that I read s apIg ation and state that the above information is correct and agree to comply with all requirements
contained herein and City ow- Colli o dinan Zan tate laws regulating building construction. /
Applicant Signature Z Print Name _lonnt d4A ( (j'� Phone 1 �'
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE