HomeMy WebLinkAbout2554 Midpoint Dr - Applications/New Commercial - 06/03/2010City of I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collins 281 N College Ave Fort Collins CO 80522 0580 Phone 970 221 6760
/ www fcgov corn/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER I no�L,°l qq APPLICATION DATE S /--j -I Q
Job Site Address Q, S q NlIii d + _Dir- Unit # nl h
To,+ C O(I �, s o PROPERTY OWNER INFO (All owner information is required- it is
not optional) Phone # C61_70, 5 G Z O 35
Last name --By rA e First Name Tamar- l Middle ri.LC e,
Street Address 30o La_o v4 e a, City 1�70 Co l L i> S State C- O Zip
CONTRACTOR INFO Company Name �3r164_C.4�_ y rtie, Contractor Phone #
Lic Holder Name r k Ce.rsy r h e, City of Fort Collins License # a b Supervisor Cert # 1J
Mailing Address 3 0 o La^fo j � ay t City V; A C'o l i i w S State C O Zip .9M57.
LEGALINFO
Subdivision/PUD L e+ aD Filing # ? Lot #_;�L Block # Lot Sq Ft
;5 k s a ¢ r 1;
CONSTRUCTION INFO (Total Building Sq Ft ( t I d g b m t) 10000 Total Garage Sq Ft t4 i
Residential Sq Ft Comm 1 Sq Ft 10,00 -0 # of Stories_ Bldg Height ( # Dwelling Units
1 Floor Sq Ft 10�— 2nd Floor Sq Ft 3 Floor Sq Ft 14 k Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft �J # of Bedrooms # of Full Baths / Baths / Baths # of Fireplaces
Air Conditioning S
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 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) $ �00
Description of Work I -
Contact Name & Phone # of JOBSITE SUPERVISOR- rw- — I -7D) �S_(G " 7`03S
Subcontractor Info r
Electrical 1JtL-k%ok5a n 91cctf C Mechanical
Framer dn.i,n fi_d Roofing
Solar
Other
Concrete —
--
Plumbing
Fireplace —
Other 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 Coll ns ordinances and state laws regulating building construction
(quo)
Applicant Signature Print Name ►�LL r Phone $lo 7 O �
Distribution White - Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE