HomeMy WebLinkAbout3626 Big Dipper Dr - Applications/Single Family New - 08/12/2005BUILDING PERMITS & INSPECTIONS DIVISION
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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 :b A_/ 5 V 4-0 -7 APPLICATION DATE D 1 VJ
Job Site Address
Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # �
First Name Middle
: Md0�
CONTRACTOR INFO: Company Name--t[t� Contractor Phone # 303- U
Lic. Holder Name �11 I k-. `, City of Fort Collins License #-qk�_ Supervisor Cert # R 0�
Mailing Address City
LEGAL INFO:
State Zip,
Subdivision/PU� Filing # / Lot # ! 0 Block #-0— Lot Sq Fti:�-
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) ( Total Garage Sq Ft ((�G]
Residential Sq Ft Comm] Sq Ft # of Stories Bldg Height # Dwelling Units
1st Floor Sq Ft _ 2nd Floor Sq Ft Unfinished Bsmt Sq FtS?� L Finished Bsmt Sq Ft
# of Bedrooms _ # of Full Baths % Baths 'Y2 Baths # of Fireplaces
Air Conditioning: Yes No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door -Star Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # / List appropriate option #s i 3
UTILITIES INFO:
Water Tap Size &/q Sewer Tap Size </ Metered:LYes/or No Temp. Pedestal: es r No
Type of Heat: Gas ❑ Electric Electric Main Breaker Size (Residential only): )c'150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction dincluding labor,.material & profit) $ / `7 , A 7 & .,Do
Description
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: ,_n C
Electrical J,)11) 0 0 17-4 r Mechanical plumbing
Frame oofing ( /Yl b0 l 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.
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Applicant Signat [ [ J� � Print Namd! ' 4l.kau- Phone T-C>-j r I
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE