HomeMy WebLinkAbout2212 Loyola Ave - Applications/Addition or Alteration - 09/01/2010City of
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
FOI t Collins 281 N College Ave Fort Collins, CO 80522 0580 Phone 970 221 6760
www fcgov com/building I
BUILDING PERMIT APPLICATION
APPLICATION NUMBER iw 5(� APPLICATION DATE
Job Site Address
Unit #
PROPERTY OWNER INFO (All owner information is required -it is not optional) Phone #
Last name— M 1 \ First Namtej 1 Middle G
Street Address City-"S—N�(� C� \� StateC6_L_Zip O
CONTRACTOR INFO Company Name G� �--��,� Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address �� �Y� �r"r� City `�0)VN\ State `• Zip
LEGALINFO
Subdivision/Pl l Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO Total uilding Sq Ft (not including basement)
Total Garage Sq Ft
Residential Sq Ft Comm I Sq Ft # of Stories Bldg Height # Dwelling Units
1 "i Floor Sq Ft
Finished Bsmt Sq Ft
Air Conditioning Yes No
3 ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO
2 d Floor Sq Ft
3 d Floor Sq Ft
# of Bedrooms # of Full Baths 3/, Baths
Unfiished Bsmt Sq Ft _
Y2 Baths # of Fireplaces
Energy info ( Circle appropriate choice ) 1 ComCheck 2 ResCheck w/Air Sealing
4 Simulated Performance Alternative 5 Prescriptive w/Air Sealing 6 Prescriptive w/ Blower Door
List appropriate option
Water Tap Size Sewer Tap Size Met red Yes or No Temp Pedestal Yes or�o
Type of Heat Gas ❑ Electric Electric Main Breaker Size (Residential only) —A 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor material & profit) $�
% — % / A _ 1 A _n t
Description of Work
Contact Name & Phone # of JOBSITE SUPERVISOR
Subcontractor Info n
Electrical [kC Mechanical �,C , a t ,IT Plumbing
9
Framer Roofing
Solar Other
Concrete
Other
Fireplace
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 he n i y ollins ordinances and state laws regulating building construction Applicant ---
Si r Print NamePhone
Distribution White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE