HomeMy WebLinkAbout2144 Clipper Way - Applications/Deck - 07/19/2005BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
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www.fcgoV.com/ruildms
City of Fort Collins BUILDING PERMIT APPLICATION
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APPLICATION NUMBER APPLICATION DATE
Job Site Address
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone #
Last N
First Name
Unit #
Middle
Street Address // City State Zip
CONTRACTOR INFO: Company Name C�/��X/� lC Contractor Phone #
Lic. Holder Name JyG� 114Oik/ City of Fort Collins License # Supervisor Cert #
Mailing Address
LEGAL INFO:
City.
Subdivision/PUD YiY1' �G�'e�"�4 y Filing #.
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) _
Residential Sq Ft Comm'I Sq Ft # of Stories
1st Floor Sq Ft
# of Bedrooms
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
State Zip
Lot # 102. Block # Lot Sq Ft.�
Total Garage Sq Ft
Bldg Height # Dwelling Units
2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Full Baths % Baths '/z 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
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: M A ; e ��G/e zq! �
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical / Mechanical Plumbing
Framer L�� 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- 7?�
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE