HomeMy WebLinkAbout3651 Little Dipper Dr - Applications/Basement Finish - 10/06/2010City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER A 3 / o`--- APPLICATION DATE
Job Site Address 3 Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # e3— ,2— 6 / s�o
Last name .S c-, ► ct G c, e- First Name j fJ 4 Middle
Street Address 3 6 -5 / 1, ; -HIP- 0 t 0 As2 City t - Cy P 1 h S State CD zip
CONTRACTOR INFO: Company NameSjT rim -So u %/rntS Contractor Phone # Of 631- 3 y S /
Lic Holder Name T oty\ 1✓L 1 City of Fort Collins License # - G / q Supervisor Cert #,2 9,20-5 lffijf
Mailing Address.27S6 Qe u 5A. G�.Q-/L �n - City /='/ C-o / i in s State GD Zip
LEGAL INFO:
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'I Sq Ft # of Stories Bldg Height # Dwelling Units
15t Floor Sq Ft
2nd Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft 107 # 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 #
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) $
Description of Work: 0 aS:�:� ` O{ /L J n - S -''1 `
Contact Name & Phone # of JOBSITE SUPERVISOR: % ^ ? 1 , 2 9 Q-6 .3/ — 3 `z'S/
Subcontractor Info:
Electrical C-dr Mechanical PSI` �e--% Plumbing A % 4
Framer!� r,._ffe.,.a_ SOI. Roofing
Solar
Other
Concrete
Other
Fireplace �/� �,►S
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 f -- ti �lti(�QiC�C_, Print Name / & '�1'1 / (--� Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE