HomeMy WebLinkAbout1713 W Lake St - Applications/Deck - 12/10/2009w BUILDING PERMITS & INSPECTIONS DIVISION
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 v APPLICATION DATE < `— ✓/� � ,
Job Site Address 1 -7 1 W , LAK5 ! '. f0Kr COLD N5 Unit #
T— 170 -�f�Z-�923 PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone #
Last Name 4/vo F, &Arj First Name , Middle
Street Address 1 7/3 ky • L.A/KE ST City f-eRi' CULL-/NS State CO Zip
CONTRACTOR INFO: Company Name .5 L) AJ PE 'K 1>E!51Z V� Contractor Phone # q7O — 690 " 9�/3 7
Lic. Holder Name _ 167YN MjL> 1J9P City of Fort Collins License # 1iZ-L7 Supervisor Cert #
Mailing Address 2.940 WQF-7-0/0670N ME City ?::4R7- 694LL/N$ State C&I Zip J;0524
LEGAL INFO:
Subdivision/PUD j/A /e2 L/ZEN "!9r Filing # Lot # u Block #_2, Lot Sq Ft ab
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I 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
Air Conditioning: Yes No
# of Full Baths % Baths % Baths # of Fireplaces
Energy info: (Circle appropriate choice) 1. ComCheck 2. ResChedk 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) $
Description of Work: %Z x /Z DEGK , gA1 W /U Cr AND Div ke-S
Contact Name & Phone # of JOBSITE SUPERVISOR: J61N Rogi pe AKm
Subcontractor Info:
Electrical
Framer
Mechanical
Roofing Concrete
Plumbing
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.
Applicant Signature Print Name Phone
Distribution: White — Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE