HomeMy WebLinkAbout544 Jansen Dr - Applications/Basement Finish - 06/28/2010COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N College Ave Fort Collins CO 80522 0580 Phone 970 221 6760
www fcgov corn/budding
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 0-0 Ae;lV APPLICATION DATE
*b Site Address z T_ f. �l �C:e L ... �� Unit #
�/ � TT— o- `�
i��ROPERTY OWNER INFO (All owner information is required - it is not optional) Phone # f !n (2` �2 ` — 9�
Last name First Name _. Middle
Street Address �t( L.�`p,,,_ City State C,7�v Zip
ONTRACTOR INFO Company Name
Lic Holder Name
Mailing
Residential Sq Ft
1 Floor Sq Ft
Contractor Phone
City of Fort Collins License # Supervisor Cert #
City State Zip
Filing # Lot # Block # Lot Sq Ft
Total Building Sq Ft ( t I d g b in t) Total Garage Sq Ft
I Sq Ft
2 IT(Qor Sq Ft
# of Stories Bldg Height # Dwelling Units
3 Floor Sq Ft
Unfiished Bsmt Sq Ft
kinished Bsmt Sq Ft # of Bedro s # of Full Baths / Baths / Baths # of Fireplaces
Air Conditioning Yes No Energy info ( le appropriate choice) 1 ComCheck 2 ResCheck w/Air Sealing
3 ResCheck w/Blower Door 4 Simulated Performance rnative 5 Prescriptive w/Air Sealing 6 Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO
List arrpkopriate option
Water Tap Size Sewer Tap Size Metered Ye8
Type of Heat ❑ Gas ❑ Electric Electric Main Breaker Size (Residential
Y/aiue of Construction (including labor material & profit) $
of Work
Contact Name & Phone # of JOBSITE SUPERVISOR
Subcontractor Info
ectncal Mechanical
Framer Roofing
Solar Other
Concrete
Other
or No Temp Pedestal Yes or No
❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Plumbing
Fireplace
Other
It.
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 7—JS—y�
Applicant Signature Print Name _� fiK Phone
Distribution White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE