HomeMy WebLinkAbout2150 Clipper Way - Applications/Deck - 07/19/2005BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
Citv of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER JJV �—/ C� APPLICATION DATE /
Job Site Address /�� �//,�i�� I&Y Unit #
PROPERTY OWNER INFO: (All owner information is required — it is not optional)
Last Name�iFirst Name
Phone #
Middle
Street Address City State f/ Zip
CONTRACTOR INFO: -~Company Name �` �/ c �' ~--'5 Contractor Phone��//# �U� 7 �2—IXJZS
Lic. Holder Name ✓ !%� /� -? / City of Fort Collins License # /✓— 7l Supervisor Cert #
Mailing Address
City.
State Zip
LEGAL INFO: Q
Subdivision/PUD [� /`� 1'6'/ 1' 10yFiling # Lot # ( Block #—Lb— Lot Sq F
34x�
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft Comm'] Sq
1st Floor Sq Ft
# of Bedrooms
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft _
# of Full Baths % Baths '/2 Baths # of Fireplaces
Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
List appropriate option #s.
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) $ it !fi3&
Description of Work: -,K5W6 /I Z79 e
3
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical Mechanical Plumbing
Framer ZbIe, 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.
Applicant Signature. Print Name ���� Phone��
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE