HomeMy WebLinkAbout5402 Copernicus Dr - Applications/Patio Cover Or Sun Shade - 08/12/2011CityofCOMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rt`Collins 281 N. College Ave. • Fort Collins, CO 805224580 •. Phone: 970-221-6760
www.tegov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER _ V _ - APPUCATION DATE
Job Site Address Unit#
PROPERTY OWNER INFO: (All owner information is required - it,is not optional) Phone #!
Last name �M 4.4 AL i_ First Name /,-f awe x ev Middle_
Street.Address 0-;2, C 0 la e. -PL e.,us City 0C I i, Ca j 1.l A'( - - State co zip
CONTRACTOR INFO: Company Name512 i.0-h/ &&L-Salt, Contractor Phone # q /Q K31-3 I;V /
Lie Holder Name IL7_0-rr 4.1 City of FortCollins License # _jOr 6__/_9' Supervisor Certa 7�b-Z
Mailing Address , 7S6 Bf`a-S Ii C4LOAsfL D r , Cite!�01/ State C-0 Zip g"4 s _-Z �.
Subdivision/PUD -_ -_ _ Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO:. Total Building Sq Ft (not including basement) ___ __ _ . Total Garage Sq Ft
Residential Sq Ft Comm'l Sq Ft # of Stories Bldg Height # Dwelling Units
111 Floor Sq Ft 2"d Floor S_q Ft __ __ — __ . 3nd Floor Sq Ft Unfiished Bsrnt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms _ _ # of Full Baths '/ Baths '/2 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. 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) $-/0 D oZ
Description of Work: %0 at t) D Ly V «e-sQ_
Contact Name & Phone # of JOBSWE SUP ERVISOR:-rb/r'1 ! ` i % h2 9 7V-G3/-3 41 S
Subcontractor Info:
Electrical
Mechanical _
— Plumbing
Framer _ Roofing _ Concrete. _ _ . ... _ _ Fireplace
Solar Other 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 Collins ordinances and state laws regulating building construction.
/
Applicant Signature 7—h- 1 Print Name / T & y►1 Phone 9 9 �' 3
Distribution: White _ Office Yellow- Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE