HomeMy WebLinkAbout137 Mathews St - Applications/Addition or Alteration - 04/07/2011City of
F6rt Collins
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APPLICATION
Job Site
COMMUNIITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone:,970-221-6760
www.fd9awcont/building
BUILDING PERMIT APPLICATION
APPLICATION DATE. —7—
F�'• COI►i'�5,6D Unit#
PROPERTY OWNER INFO: (All owner information is required - it is not opptiional) Phone #
Last name St C�. First. Name R 1rC l ND Middle. E
Street Address -1 (� BrWk�ter PIr . City _ Ccvl rrxs State `� Zip � Z
CONTRACTOR INFO: Company Name _ _ Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address City _ State Zip
LEGAL INFO: �7!
Subdivision/PUD Filing # Lot # Gas Block # i3 l Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) �� Total Garage Sq Ft
Residential Sq Ft 3� �J Comm'I Sq Ft # of Stories Z Bldg Height Z(0# Dwelling Units Z
1 er Floor Sq Ft i 179 2nd Floor Sq Ft 3'd Floor Sq Ft _ Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths 14 3/4 Baths '/2 Baths Z # of Fireplaces Z
Air Conditioning: es /No Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. Simulated Performance Alternative 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
Type of Heat: 56Gas 7 Electric Electric Main Breaki
Value of Construction (including labor, material & profit)
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Subcontractor Info:
no VA't1m CaTa Cod
4 d Taw n . 24!>153
„rn _ cv i ! l � ec�nstru e
Electrical Mechanical
Framer Roofing
Metered Yes r No Temp. Pedestal Q2sAr
p_( Wi¢erlial omly) _ ❑ 150 Amp or Less X 200 Amp
1stma +a rcrm rr%.
OC. w
Concrete
4
Plumbing
Fireplace
Solar Other _ Other _ Other
0
0 Other
J,.,
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 Qgiflins ordinances and state laws regulating building construction. G
Applicant Signature. �iE Print Name � YID . lj S�>( Phone 9717 • Zi4 - l Z06
c 4no 5eA-@ gll/h ij l cep �C
Distribution: White — Office Yellow — Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE