HomeMy WebLinkAbout2640 W Prospect Rd - Applications/Addition or Alteration - 01/31/2011City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rtCollins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
wvvw.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER Lb I APPLICATION DATE 001 / Zo l
Job Site Address
Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # " 1, ld `7 "l t0 L�
Last name �j �Gt YZ ► First Name �� \ f�� Middle ¢ s
Street Address, Pros Pe4= NA City 1'} . LD �t Y15 State Zip U U ✓�
CONTRACTOR INFO: Company Name 6 l ct n'1 i i-fir^ 1 on Contractor Phone # � { L� `4 � d- q6 c!57
Lic Holder Name + pCity of Fort Collins License # Supervisor Cert #
Mailing Address Z6 �I b ` �r(�S I���� kd City ► � l l i� S State Zip sbn�&
LEGAL INFO: I _ � /� a
Subdivision/PUD �C� i�a ll SPX 1';PG�CI�UI�i G)Filinq # Lot # ck # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) pC o 3 d� Total Garage Sq Ft
Residential Sq Ft 0o3a Comm'I Sq Ft // # of Stories Bldg Height C )) #Dwelling Units
15' Floor Sq Ft !o (00 2"d Floor Sq Ft o� 3rd Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms T # of Full Baths �- 1/4 Baths D '/2 Baths V # of Fireplaces
Air Conditioning: Ye 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 #
List appropriate option
UTILITIES INFO:
1'
Water Tap Size Sewer Tap Size Metered: Yes or No
Type of Heat: bKGas ❑ Electric Electric Main Breaker Size (Residential only)
Value of Construction (including labor, material & profit) $
aq n� o ale``
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Temp. Pedestal Yes or No
150 Amp or Less ❑ 200 Amp ❑ 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 City of -QelA finances and state laws regulating building construction.
Applicant Signature Print Name n f rf Phone d�r a) 412
-`/64/5
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE