HomeMy WebLinkAbout5114 Old Mill Rd - Applications/Single Family New - 05/10/2005arc} BUILDING 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 NUMBERZ APPLICATION DATE
Job Site Address. //'`�% QG4) g/ Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional)
Last Name.S%42f/aA2/� P,QC *A'c -"�First Name
Phone # •?03 -775 -Cf(o
Middle
Street Address (ePO s s„y�'?gCy;r ��_ City /j State c-U zip (0o�,s�`7
CONTRACTOR INFO: Company NameS7--4, b, Ai',/ /9•¢l,',4,"C:- Contractor Phone # ?ea?-8-rf0¢- 8S 3
Lic. Holder Name1)d6e/Z City of Fort Collins License #c??IIA -O.), Supervisor Cert #�'
Mailing Address k6c0 4- Cit&-/z State C'.j�D zip
LEGAL INFO:
Subdivision/PUD &4 k'ycA--Sj7- t?q/2K Filing # �� Lot # r -! Block # Lot Sq Ft j 7
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) a. Total Garage Sq Ftia
Residential Sq Ft �J Comm'I Sq Ft- Q # of Stories Bldg Height_ # Dwelling Units
15t Floor Sq Ft &O2nd Floor Sq Ft %1 8 Unfinished Bsmt Sq Ft _r7U Finished Bsmt Sq Ft f�
# of Bedrooms OC # of Full Baths a % Baths 1/2Baths I # of Fireplaces - -
Air Conditioning: Yes K No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
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 # cList appropriate option #s
UTILITIES INFO:
A I �i
Water Tap Size �- Sewer Tap Size 1 Metere 15,
or No Temp. Pedestal�or No
Type of Heat: )(Gas ❑ Electric Electric Main Breaker Size (Residential only):,J�(150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ ba 10 71t , ad
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:�,t/'1"
Subcontractor Info: /
ElectricalMechanical AIL s Plumbing_
Framer K Roofing Concrete j�¢Z &.-¢S 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 -4.gPrint Name /yE✓� t rG Z-QUjz 5 Phone SrG �5
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE