HomeMy WebLinkAbout3909 Grand Canyon St - Applications/Basement Finish - 12/03/2009BiUILDING PERMITS & INSPECTIONS DIVISION
PO Box 580 - Fort Collins, CO 80522-0580 - Phone 221-6760
www fcgoV coin/building
CAV of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER W 0-7-70_� APPLICATION DATE /6� v O.
Job Site Address (-MO `" I Cq�4�a Unit #
PROPERTY OWNER INFO (Ali owner information is required - it is not optional) Phone # N702 —0 a - 6"ES%
Last Name l�r�r First Name t'sa� Middle
Street Address 3goq Cars�an G4�v�laJ Si]e City 1;; T csu_rsS State Gp Zip
CONTRACTOR INFO Company Name
Lic Holder Name
Mailing Address
LEGAL INFO
Subdivision/PUD
Contractor Phone #
City of Fort Collins License # Supervisor Cert #,
City State Zip,
Filing # Lot #,
CONSTRUCTION INFO Total Building Sq Ft (not including basement)
Residential Sq Ft
151 Floor Sq Ft
# of Bedrooms
Air Conditioning Yes No
3 ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO
Block # Lot Sq Ft
Total Garage Sq Ft
Comm I Sq Ft # of Stones Bldg Height # Dwelling Units
2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Full Baths % Baths '/2 Baths # of Fireplaces
Energy info (Circle appropriate choice) 1 ComCheck 2 ResCheck w/Air Sealing
4 E Star w/Blower Door 5 Prescriptive w/Air Sealing 6 Prescriptive w/Blower Door
List appropriate option
Water Tap Size Sewer Tap Size 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) $ V . ! 77,
escnption of Work "4t4 r, Age e6ow 4. %k174 G.d�/1/ .F� k4tMA
Y?-q S a?y-r Ian sin. 4q--T.
Contact Name & Phone # of JOBSITE SUPERVISOR
Subcontractor Info
Electrical Mechanical �,idC' �I 4.T�2 Sr Plumbing ��� VL_, ^ATZ �.IZt
Framer
Roofing
Concrete
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
-+ApplicantSignature� / Print Name Ysa�.I C4AC- r� PhoneCV62 2-0 Co
Distribution White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE