HomeMy WebLinkAbout5209 Black Bark Ct - Applications/Patio Cover Or Sun Shade - 05/06/2005APPLICATION NUMBE
Job Site Address
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION
e/ ( _ Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 'a- (u - IS05—
Last Name M1�'fr7nC.�S `` n,nn rFFirst Name �-� �' ..�t'V�� Middle r
Street Address -5 -09 `g G..ACK _M0 IL CT, ,, city,'1,r / u� r State � �G Ziipp Z> — `—
CONTRACTOR INFO: Comp =f4AIJ
� r"�N WF�1� "Contractor Phone # -79,
Lic. Holder Name N City of Fort Collins License # �- l Supervisor Cert #
Mailing Address 7Q &C, �� City 44Y Gam- ^—P State 69::� Zip (V')
V1-
LEGAL INFO: '. I
Subdivision/PUD Filing #
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Lot # Block # Lot Sq Ft �M
Total Garage Sq Ft (�
Residential Sq Ft » Comm'I Sq Ft # of Stories 2 Bldg Height 2 r # Dwelling Units
15t Floor Sq Ft 2nd Floor Sq Ft j n n� Unfinished Bsmt Sq Ft 2 00 Finished Bsmt Sq Ft (� 6
# of Bedrooms E` # of Full Baths 3/ Baths _ _ 'Y2 Baths # of Fireplaces
Air Conditioning., Ye No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing t�
3. ResCheck w/Blower Door 4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # List appropriate option #s
UTILITIES INFO:
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 )2-200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ Jo, 0o 0
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
2-79 f�SO
i-V 144-
Electrical _(ten E'L o2 ti% Mechanical N/A Plumbing Cow i2"D
Framer 1 Roofing rt, n/7 �Cc-AE Concrete, Other
Applicant: I hereby acknowledg 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 ordinances afidAtate laws regulating building construction. f
Applicant Signature Int Name (mil Phone ,27`�� O
_ � 3
Distri tion: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE