HomeMy WebLinkAbout821 Province Rd - Applications/Basement Finish - 12/28/2010City 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 10031 I] APPLICATION DATE (I-).�(t Vi�I,Y�P j� Sil .�)Lti1®
Job Site Address. FTZ1 10R-avitt2cu- Unit 0.
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone #
Last name Baiwo First Name -i 0&n.;W Middle
Street Address elt F� City /,� 1" !, State�Zip- ka
CONTRACTOR INFO: Company Name
Lic Holder Name
Contractor Phone #
City of Fort Collins License # Supervisor Cert #
Mailing Address City
State
Zip
LEGAL INFO:
Subdivision/PUD "eNCL? T- OLL9AJ Filing # Lot # Block # Lot Sq Ft,
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm] Sq Ft # of Stories Bldg Height # Dwelling Units
151 Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft Unfiished Bsmt Sq Ft _
Finished Bsmt Sq Ft # 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 #s
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal Yes or No
jTypeofHeat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less- ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ q t 3yJ , �C) (61D ' 3b ,Pee &q-R ia1 tr)
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Mechanical
Roofing Concrete
Other Other
Plumbing
Fireplace
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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 F WOoliins and tete laws regulating building construction.
Applicant Signat Print Name Phonel377-ZZ/yb
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE