HomeMy WebLinkAbout3526 Shallow Pond Dr - Applications/Basement Finish - 01/28/2014COMMUNITY 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 I HO V H, 3 71 APPLICATION DATE
Job Site Address 3'5ZL
c,l loc j
Unit #
PROPERTY OWNER INFO: {�(iIAll owner information is required - it is not optional) Phone # t)� ' "' L I 0113
Last name Iv a Wik First Name -ya-sID^ Middle
Street Address S Z � � V` � � I O`, I b� ity T { - Co' Ii G� ► gState Zip
CONTRACTOR INFO: Com any Name - J WLI Contractor Phone # /'70 - 51D - 65DQ
Lic Holder Name W�l fq &V
t Aw
City of Fort
lCollins
' License # -�3ySupervisor Cert # 7 ,�
Mailing Address ✓ tky't-t tulA City l` * l� /�lS State w Zip p b5'�T
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'I Sq
1s' Floor Sq Ft
2nd Floor Sq Ft
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished 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:
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)
Description of Work: PaICtMck -+- A—%L- ��. — Ot&0074^ 1 )--X'+1'1 I CJIAc aUo�
Contact Name & Phone # of JOBSITE SUPERVISOR:
Th)-` IC>- 65a8
1
SubcontractorinTfo:.,%t�tci
Electrical & -I Mechanical t� Slut Plumbing
Framer A- - (/4 Roofing Concrete Fireplace
Solar Other Other 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 Wns ordinances and state laws regulating building co s ructi n.
Applicant Signature U p Print Name LA Ytjf'Cf/ Phone916
Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater
THUS APPLUCATROM EXPO RES 180 DAYS FROM APPLUCATIOM DATE