HomeMy WebLinkAbout2227 Marshfield Ln - Applications/Single Family New - 03/24/2010i 3
BUILDING PERMITS 8L INSPECTIONS DIVISION
P.O. Box 580 •Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building l Kr
City of Fort Collins
BUILDING PERMIT APPLICATION
APPLICATION NUMBER J )� C�C� ��� i / APPLICATION DATE I �b
Job Site Address
e_ Uniit�#�
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last Name lvt nit /Vc �a+�(l First/Name Middle
Street Address 363.7 , 1 e• T Ay*-- city aJJ,- State _(_6 _zip g -39
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CONTRACTOR INFO: Company Name �Sa� S 6r6160)of_ContractorPhone#
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Lic. Holder Name i&v City of Fort Collins License # bq lej Supervisor Cert # �'?p��
Mailing Address 303 City LOVct/AK% State CD Zip gt3 S3�
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LEGAL INFO:
Subdivision/PUD e- ! ' Filing # f�p Lot # ✓ Block # 02 Lot S t S7
CONSTRUCTION INFO: Cal Building Sq Ft (not including basement) ' 1 1 Total Garage Sq Ft
Residential Sq Ft 11 27 Comm'I Sq Ft # of Stories_ Bldg Height 12/ # Dwelling Units
1st Floor Sq Ft I ) ? 2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Bedrooms 3 # of Full Baths C2 1/, Baths /z 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 #sS
UTILITIES INFO: £L� Jcac21C12
Water Tap Size Sewer Tap Size Metered: to or No �/ Temp. Pedestal: es or No
Type of Heat: DGas ❑ Electric Electric Main Breaker Size (Residential only): �p 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ /00,to/t'
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR:
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Subcontractor Info:rlwu / /�/ D
Electrical R Mechanical 11 4cl 1� C"t %/ // Plumbing ��fT
Framer Roofing �.e-j,_T TutL r Concrete VN16telk r /"(4S✓n
Applicant: I hereb acknowledge that I have re s plication and state that the above information is correct and agree to comply with all requirements
contained herein and ins or ' es n state laws regulating building construction.
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Applicant Signa ure Print Name bCr-1 Phone 5k _7 5 /
White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE