HomeMy WebLinkAbout2745 Annelise Way - Applications/Basement Finish - 07/14/2010City 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/budding
BUILDING PERMIT APPLICATION
APPLICATION NUMBER��/ C ' / APPLICATION DATE
Job Site Address
Unit #
PROPERTY OWNER INFO (All owner information is required - it is not optional) Phone # 7 ?i T 7 • I
Last name S f' 1 01/1 `i n First Name To n // Middle
Street Address 7 S �fi City �'r C& (/i'n J State-61�ZipQ02.
CONTRACTOR INFO Company Name S e" L Contractor Phone # 1-70 , 6::Z q ? SO c)
Lic Holder Name QPO GIB t j (Z�j}r. rr {, * Cify of Fort Collins License # 1%-_77 Supervisor Cert #
Mailing Address 0 Qo K .271 7016 City P1TllC State _ Zip 264 i.7
LEGAL INFO
Subdivision/PUD
CONSTRUCTION INFO Total Building Sq Ft (not including
Filing # Lot #_
Block # Lot Sq Ft
Total Garage Sq Ft
Residential Sq Ft Comm I Sq Ft # of Stories Bldg Height # Dwelling Units
1" Floor Sq Ft 2 d Floor Sq Ft _
Finished Bsmt Sq Ft �7 # of Bedrooms
3 d Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Full Baths 1/4 Baths % 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 #
UTILITIES INFO
Water Tap Size Sewer Tap Size
Type of Heat ❑ Gas ❑ Electric Electric Main
Value of Construction (including labor material & profit)
Description of Work
Contact Name & Phone # of JOBSITE SUPERVISOR
Subcontractor Info
List appropriate option
0
Metered Yes or No Temp Pedestal Yes or No
Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Electrical 7Lr i t' "t- / Mechanical ORYxc Plumbing L"�ifyf�t rt-ntW�'
Framer -, t� c �J Roofing Concrete Fireplace
Solar
Other
Other
Other
Applicant I hereby acknowledge t I h je
s application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fo n rdand state laws regulating building construction
Applicant Signature Print Name -ti+ Phone 7 qS'gQ
Dis ribution White — Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE