HomeMy WebLinkAbout2059 Vermont Dr - Applications/Other - 10/05/2009APPLICATION N
Job Site
BUILDING PERMITS & INSPECTIONS DIVISION
PO Box 580 Fort Collins, CO 80522-0580 Phone 2216760
WWW fcgov com/buildmg
BUILDING PERMIT APPLICATION
0
APPLICATION DATE I0/Os brzf
Unit #
PROPERTY OWNER INFOy (All owner information is required - it is not optional) Phone #_
Last Name ��(,ti /'t�/J'8�� First Name
Middle
Street Address 306-7 114y"" u✓L, City /1�7j 6,OL FgS State (fa Zip e0S_ZS
CONTRACTOR INFO Company Name _/_:6b Contractor Phone #
Lic Holder Name
City of Fort Collins License # Supervisor Cert #
Mailing Address City. State Zip
LEGAL INFO
Subdivision/PUD,4L,-Ljt6l/d/C_ P_Li4Zi¢ AeO 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 Stones 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 A Baths / Baths
Air Conditioning Yes No Energy info (Circle appropriate choice) 1 ComCheck
3 ResCheck w/Blower Door 4 E Star w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO
5 Prescriptive w/Air Sealing
List appropriate option
# of Fireplaces
2 ResCheck w/Air Sealing
6 Prescriptive w/Blower Door
Water Tap Size iSewer Tap Size W-A 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) s�2310w
DescnptonofWork 1&S1Wu 4?-xW 6of r /JZW0*_ir1r_ /Q/c_C.-/ lyLJi-Ilt-e W17W
Contact Name & Phone # of JOBSITE SUPERVISOR T�rf/lll �SiC14k_L / (3G3) ga/-/fit/%
Subcontractor Info
Electrical Mechanical
Plumbing
Framer Roofing Concrete Other
Applicant I hereby acknowledge that I have pad this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort s ances a d st laws regulating building construction !�
Applicant Signature Print Name � /� CS/4/' AGc Phone 43D33)6s"! b0yll,
Distribution White - Office Yellow -Applicant Pink - VWVW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE
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