HomeMy WebLinkAbout2539 Rock Creek Dr - Applications/Basement Finish - 09/03/2010COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
City of
Fort Collins
281 N College Ave Fort Collins CO 80522 0580 Phone 970 221 6760
www fcgov cam/budding 4379 02(/
BUILDING PERMIT APPLICATION
APPLICATION NUMBER -1:) 180 L JUQ q APPLICATION DATE q co to
)-Job Site Address ),539 2,cfC (/, �(C QQ- Unit #.
PROPERTY OWNER INFO (All owner information is required - it is not optional) Phone #
y� S
Last name 1,1 r N, Tbwt� First Name I" -A #-4 /� Middle
Street Address 1S35 Rc -/C 6rc-c� OIL �C City �d lbf �j StateCd Zip G5-2
CONTRACTOR INFO Company Name
Lic Holder Name
Contractor Phone #
City of Fort Collins License # Supervisor Cart #
Mailing Address City State Zip
GAL INFO le�wCE[ A, l b `!% Z.SS/
Subdivision/PUD it(LQ ; 5 T Filing # Lot # % Block # 7 Lot Sq Ft
CONSTRUCTION INFO Total Building Sq Ft ( t Cl d g b m
Residential Sq Ft Comm I Sq
Floor Sq Ft
2 d Floor Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3 d Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft Y 66 # of Bedrooms # of Full Baths / 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
List appropriate option
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) $ la, I
+Description of Work j3A<1-,- w Vf.. i f i- 5 N
Contact Name & Phone # of JOBSITE SUPERVISOR
Subcontractor Info /
Electrical DL So ck Mechanical 64A)/ .t� �EL'/�HN��,r L Plumbing 1'PfP'U4F—
Framer
Roofing
Concrete
Fireplace
Solar Other Other Other
Applicant I hereby acknow t I e read tNs ap tion and state that the above information is correct and agree to comply with all requirements
contained herein and City Ilin an state laws regulating building construction 4
*-Applicant Signature Print Name Ai K V 4 '' Phone 40!
Distribution White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE