HomeMy WebLinkAbout3515 Long Creek Dr - Applications/Single Family New - 05/19/2005BUILDING PERMITS & INSPECTIONS DIVISION
' P.O. Box 580 •Fort Collins, CO 80522-0580 • Phone: 221-6760
www.kgov.com/building
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER y v L� APPLICATION DATE
Job Site AddressUnit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last Name7f3A % rs First Name Middle
Street Address City State Zip
CONTRACTOR INFO: Company Nam Id-tvrs Contractor Phone # 6—Y16 -3
Lic. Holder Name&Uj d- S S/ a City of Fort Collins License # l30 Supervisor Cert #it/?
Mailing Address (J "X'5/ -s-Lgq �- FD`[ye, tiZ)nz< City 60tq &50 State CO Zip cCy-524:91, b
LEGALINFO:,, �j Q'
Subdivision/PUDy/l i\�- Filing # r Lot #_� Block # CJ Lot Sq Ft
CONSTRUCTION IN22FO: Total Building Sq Ft (not including basement) �1�) Total Garage Sq Ft 67,5
Residential S y!/ q FtComm'I Sq Ft K(�' # of Stories Bldg Height #Dwelling Units
1st Floor Sq Ft 2nd Floor Sq Ft 11TI Unfinished Bsmt Sq FtFinished Bsmt Sq Ft
# of Bedrooms # of Full Baths V 3/4 Baths _6 '/2 Baths �� # of Fireplaces
Air Conditioning: Yes No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
QEeck w/Blower Door 4. E-Star w/BI wer Door 5. Prescriptive w/Air Sealing 6 Prescriptive w/Blower Door \ �,
City of Fort Collins Stock Plan # /(/ List appropriate option #s e�)A
UTILITIES INFO:
Water Tap Size_ Sewer Tap Size
Type of Heat: A-6as
❑ Electric
Metered Yes or No Temp. Pedesta Ye or No
Electric Main Breaker Size (Residential only): ❑ 150 Amp or Less ,42l*fl]l0 Amp
Contact Name & Phone # of JOBSITE SUPERVISOR:
❑ Other
om
Subcontractor Info:
Electrical Mechanical Plumbing
Framer t ,67A ogn'/s- `r Roofing ��S 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 Qollins ordinances and state laws regulating building construction. y�, /
Applicant Signatur Print Name,(U;!--7W S Gt� LC7 Phone( �LA�Q3
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE