HomeMy WebLinkAbout525 Dennison Ave - Applications/Basement Finish - 12/27/2010COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
City of
F6rt Collins
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER v) 6'm/ APPLICATION DATE /� �(D
Job Site Address
Unit #
PROPERTY OWNER INFO: `(All owner information is required - it is not optional) Phone # g7C2 L4p&go
Last name V I /(9Y�� 1 d. First Name PAU l _ Middle Qo
qfjONTRACTOR
Street Address a '� �iu,u►5f .iJ �"l%L- City /LT f vL,( State �e� Zip
INFO: Company Name Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address City State Zip
LEGAL INFO.
Subdivision/PUD
Filing # Lot # Block # Lot Sq Ft
ONSTRUCTION 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
15' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/2 Baths # of Fireplaces
�it 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
ity of Fort Collins Stock Plan #
JTILITIES INFO:
List appropriate option #s,
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:l ►� 1��\
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
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 herein and C y f Fort Collins ordi an es and s laws regulating building construction. �ibjn�a_�
q�.,t�� °� r +7�Applicant Signature Print NameDA4 )L c Phone / 70 f X -9J `i V
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE