HomeMy WebLinkAbout6570 Rookery Rd - Applications/Single Family New - 06/21/2005Citv of Fort Cnllinc
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www. fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 0 56 • 0 q f �� v
APPLICATION DATE
Job Site Address 6-7o igonk6ey ju Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # �I 70 ^OZ
Last Name 5'Q-A,,4f4j N First Name �AV Middle L-
Street Address t'o�$l KDoCity �PT 6aI.S State CO Zip BZ6ZR
CONTRACTOR INFO: Company NameQ�LIr1�N V�S[Cr�� rrK� Contractor Phone # qM
Lic. Holder Name 9RAN M904 City of Fort Collins License #Q-4g1() Supervisor Cert #
Mailing Address ie,0, epl[ 2Ias7h City T 6111,is State e-0 Zip ,94G
LEGAL INFO:
Subdivision/PUD AIL LAkE &NCt4 Filing # f Lot # Block # % Z Lot Sq FtZ3 Z0
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)Total Garage Sq Ft
Residential Sq Ft h23 Comm'I Sq Ft / C # of Stories Z Bldg Height # Dwelling Units
1st Floor Sq Ft 2 ! 2 2nd Floor Sq Ft [ 152- Unfinished Bsmt Sq Ftqb I- Finished Bsmt Sq Ft [p
# of Bedrooms - # of Full Baths '� '/< Baths 'Y2 Baths — # of Fireplaces
Air Conditioning: es 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 # List appropriate option #s
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: U111, or No Temp. Pedestal: & or No
Type of Heat: (Gas ❑ Electric Electric Main Breaker Size (Residential only): ❑ 150 Amp or Less k(200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ 7 56. n eQ
Description of Work: NeW 6EL - -3
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: j ,
Electrical AlAC Mi0r Mechanical &snm t't Aiim( Ata Plumbing C(�
Framer 0lZyllI7 Roofing ptp-IAC4, Concrete QAA4*- 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 Wlins, ordinances and state laws regulating building construction.
Applicant Signature Print Name\( ZOAMM641-k Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE