HomeMy WebLinkAbout5209 Country Squire Way - Applications/Single Family New - 07/13/2005BUILDING 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 NUMBER t/ `" 11 APPLICATION DATE rT
Job Site Address 4=:�[� 9 COO ". tzy (/ Unit #
10,
Phone # ,?o � '7* If " �LOy
PROPERTY OWNER INFO: (All owner information is required - it is not optional)
Last Name S%-a9- ,p 17 J04 a t1, G-First Name Middle
Street Address ��Oy S • .Sy12.�{ case Sl -IVy00 City_ b C,,V&e y State-, Zip�50
CONTRACTOR INFO: Company Name Ss r4,44'J44Cd igC', f'� C= Contractor Phone # ?6 3 -99G `91J-2.)
Lic. Holder Namebewce<- .S C<i!^e, �.0 City of Fort Collins License #(f . -7-� Supervisor Cert # 01 Y/a -C�'a
Mailing Address -Sot �� 4-5 .-;tz"we
LEGAL INFO:
City
State Zip
Subdivision/PUD Filing # I Lot # Block # /3 Lot Sq Ft /
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) 1821 Total Garage Sq Ft %r'?
Residential Sq FtO 7� Comm]Sq Ft $- # of Storiest _ Bldg Heigh#Dwelling Units
15t Floor Sq Ft % 2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft l
# of Bedrooms 3 # of Full Baths o2 % Baths 'Y2 Baths # of Fireplaces
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 Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # �.� 02 ( List appropriate option #s I
UTILITIES INFO:
Water Tap Size Sewer Tap Size t Meter Yes or No Temp. Pedesta . Ye 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) $ 1 498,
Description of Work: SZti (-4 L.f' f l-�., ; ),� �6 , tG,✓� �vr c /
OAT. �Tvdy
—,�—�lL[•0 %��5�✓�.e'.v> /�.4 Tf�' .P�� C -lid
Contact Name & Phone # of JOBSITE SUPERVISOR: L 6,�� '6 - 5--& 7 -S- -? �j
Subcontractor Info:
Electrical �C f40-z-CC Mechanical Plumbing
�- Roofing & O ��
Framer �qt g Concrete T,4 F, 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 �Lt ' } . Print Name,,,( 5Drl.ZE' Z' V0,4U Phone _?e
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE