HomeMy WebLinkAbout5309 Country Squire Way - Applications/Single Family New - 06/23/2005BUILDING PERMITS & INSPECTIONS DIVISION
` P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov com/building
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBERa5llo 36�1 APPLICATION DATE lQ V r
Job Site Address .> 20! Ca01V7-R y Sgcas,�2f !-v.9 y Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional)
Last Name T A,t/0A9 0 hAe,'f C First Name
Phone (/600
Middle
Street Address Z�' CU S�-��/2-tcuSE S�F, yoo City State c<D Zip 0093 7
CONTRACTOR INFO: Company Name Contractor Phone # .J6 "io c/6 -
Lic. Holder Name P C V,1e C- /l SCA,re, '.r. City of Fort Collins License # jfa -73 Supervisor Cert #o? %/a 'c)a
Mailing Address k66213 S. ,i��e. Cuter .SSAyo'/<9J8ity d ��r>v,f /{ State Cv Zip e 3 7
LEGAL INFO:
Subdivision/PUD #,#,ell6s% A14 k- Filing # I Lot # 13 Block #--/,j_ Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) oa 7 15- Total Garage Sq Ft > (�
Residential Sq Ft ,;?,'LU�-' Comm'I Sq Ft # of Stories Bldg Height aq # Dwelling Units /
1st Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq Ft 76,3 Finished Bsmt Sq Ft $
# of Bedrooms # of Full Baths -a 3/ Baths _ % Baths I # of Fireplaces i
Air Conditioning: Yes No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. E-Star w/Blower Do 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # List appropriate option #s 113
UTILITIES INFO:
Water Tap Size 3_!_ Sewer Tap Size_ Metere Cvor No Temp. Pedestal 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) $ �30 f% ,
Description of Work: .S-T V& C C t=� ,,, ; /Y � tr S, Gje�7-YC
1 0/07-, l�iQ�r� ,sue
S 4/4
If
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical %ST Mechanical Plumbing -46
Framer ^ 4' L Roofing & 0 1 e/ Concrete J-4 67 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 Collins ordinances and state laws regulating building construction. "
Applicant Signature ItGY.z� /� Print Name/t'/ 4- LUu2 t Phone 302 9316 -eP5* ;lam
Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE