HomeMy WebLinkAbout2439 S College Ave - Applications/Plumbing - 09/10/2009BUILDING 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 APPLICATION DATE -I� 9
Job Site Address 1411h &I.f ear AV612 e, Uppn'�it #Cj �/ p J1�
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # O, D -- I �/ "/-4//
Last Name S'�'�jawa'&K First AN,ame ( 17 E ye- /1 f Middle
Street Address z`�� / d u�ifi 6016! 7T r'� • City )CoyT' (�I�LL//IS StateOo Zip 805Z,,,5
CONTRACTOR INFO: Company
Namee lulld7LC7tontractor Phone # p
[ 70 -J��B -3`%
Lic. Holder Name Toot& 67l/ ecSp/e., City of Fort Collins License #•P'5-IS4,Z Supervisor Cert # /9I1;�<o-F5
Mailing Address. (/ . vx 60 1
City L11//2&r-)
State Zip 05T/
LEGAL INFO:
Subdivision/PUD
Filing # Lot #
Block # Lot Sq Ft
/
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft
# of Stories Bldg Height
# Dwelling Units
1st Floor Sq Ft 2nd Floor Sq Ft
Unfinished Bsmt Sq Ft
Finished Bsmt Sq Ft\
# of Bedrooms # of Full Baths
% Baths % 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 #
List appropriate option #s
UTILITIES INFO:
t�
Water Tap Size ZP Sewer Tap Size
Metered: Yes or �
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) $
&I g50, 00
Description of Work: _T+uSz AL L_t f =2r✓ L;rvc
I n)T0 ^?2o�oc�cl
1
�;3 td
CJ
= 2
vOP
Contact Name & Phone # of JOBSITE SUPERVISOR:
-2
Subcontractor Info:
Electrical Mechanical
Plumbing
Framer Roofing Concrete Other df/q &-cAyA-TjN6 K
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 rdinances and state laws regulating building construction.. /
Applicant Signature �2PS d r ti? Print Name Q°'T " ��1/49+ k' I�r5.4f�hone Z ZZ -6%�(�
ePPL11CATION
: White - Office Yellow -Applicant Pink - WWW/Stormwater
THIS EXPIRES 90 DAYS FROM APPLICATION DATE