HomeMy WebLinkAbout2657 Autumn Harvest Way - Applications/Basement Finish - 02/14/2014City of I I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Forrt Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
/,%��j� /►B/UILDING PERMIT APPLICATION
APPLICATION NUMBER BI 4 Ov `CJy! APPLICATION DATE / "//
Job Site Address 5-7- /i 4-& ' Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name � t %^^� First Naame�F t / " "fG` �'Y/, p�Middle
irp /�h�
Street Address � �^ 1 4/yq City �r� Lam! �/' '� State � Zip
CONTRACTOR INFO: Company Name
Lic Holder Name
Contractor Phone #
City of Fort Collins License # Supervisor Cart #
Mailing Address City State Zip
LEGAL INFO: L P
Subdivision/PUDal�'� ✓� / �� Filing # Lot # I, -Block #2(�-- Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft
1s' Floor Sq Ft
Comm'I Sq
2^d Floor Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3`d Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft 2L # of Bedrooms J- # of Full Baths '/, Baths -I— '/z 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: A `dii I 444 _ i' i't�/`�
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 Fo ollins ordin nd state laws regulating building construction. /
Applicant Signatu V�� - Print Name f l—y ti7K/t Phone
i
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE