HomeMy WebLinkAbout4312 Mill Creek Ct - Applications/Addition or Alteration - 08/22/2005BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER QC) 4(0 � 5 APPLICATION DATE I
Job Site Address 4- 1'L
Unit #
PROPERTY OWNER INFO: (All owner information is required — it is 7 of optional) Phone # 'f n Z 29 "71�, r1
Last Name lr{be First Name I 9 G 6 Middle
Street Address f t City T_T t l_ C 111114 rj State_N) Zip � Z —
i �^
CONTRACTOR INFO: Company Name
( �'1 �� Contractor Phone #�'Z0 (LIl ®211
Lic. Holder Name 7" ';W C T �ICity of Fort Collins License # Supervisor Cert #
Mailing Address51FC c Dr City —° U State L" Zip ��
LEGALINFO:
Subdivision/PUD W(?; f 400e Filing # Lot # AD Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'l 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 Yz 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:
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) $ ftQetl d "-D_.
Description of Work: —&, r >
Contact Name & Phone # of JOBSITE SUPERVISOR: 49
Subcontractor Info:
Electrical 'eqt Mechanical
Plumbing
Framer Roofing Concrete Other
Applicant: I hereby ac owle ge at I ha a ead t app' tion and state that the above information is correct and agree to comply with all requirements
contained herein an ity of o ollins anc nd to laws regulating building //consst/truction.
770
Applicant Signat re Print Namr� oA 6L hone �- !
Phone
Distribution: a —Office Yellow —Applicant Pink— WWW/Stor ater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE