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HomeMy WebLinkAbout1612 Tanglewood Dr - Applications/Basement Finish - 09/04/2009BUILDING 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 NUMBER -f2cC) r? L4w APPLICATION DATE ® I I © L� l Ti Job Site Address 1 02- '7jRtj(,r- e%-) o-po R t Unit # PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # � O " i` 2 - % 0 g 5 Last Name 9 t T T c P, M 4o-) First ^Name Jelry- 164-d-- ' Middle to L C E#-J Street Address ((0 [ Z. `j" ar-0 G LE t� a'r� V Q • City • �L (f S State (10 Zip ODO 's-Z'r CONTRACTOR INFO: Company Name Lic. Holder Name Mailing Address LEGAL INFO: Contractor Phone # City of Fort Collins License # Supervisor Cert #, City Subdivision/PUD PA IQV-t�a O 0 EAST Filing #. CONSTRUCTION INFO: Total Building Sq Ft (not including basement) _ Residential Sq Ft Comm'I Sq 1st Floor Sq Ft # of Bedrooms Air Conditioning: Yes No 3. ResCheck w/Blower Door City of Fort Collins Stock Plan # UTILITIES INFO: 2nd Floor Sq Ft State Zip Lot # Block # Lot Sq Total Garage Sq Ft # of Stories Bldg Height # Dwelling Units Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft '-)o;XK # of Full Baths '/< Baths '/2 Baths Energy info: (Circle appropriate choice) 1. ComCheck 4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing Water Tap Size Sewer Tap Size List appropriate option #s # of Fireplaces 2. ResCheck w/Air Sealing 6. Prescriptive w/Blower Door 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) $ 40 ,fit i Description of Work: 1 N t S a 2 ZOb MS Pt- fy!-a MINE 101ff, Li OF Contact Name & Phone # of JOBSITE SUPERVISOR: Subcontractor Info: Electrical Mechanical Plumbing Framer Roofing Concrete 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. Q `' p Applicant Signature r� — Print Name JE%�'.-� / t-Nib Phone-1� 0-70z."%C%�S Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE