HomeMy WebLinkAbout2739 Pleasant Valley Rd - Applications/Basement Finish - 02/22/2011City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER. i) 1 C) (:) —? y APPLICATION DATE ✓` J,9 /
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Job Site Address Unit #
PROPERTY
//OWNER
'' WNE// R INFO: (All owner information is required - it is not optional) Phone #
Last name WgT f.('SOY` First Namer Middle
Street Address Z 4t City /� °s��1 h S Sgtate�Zip
CONTRACTOR INFO: Company Name SOii b I Contractor Phone #
Lic Holder Name be (1i d �/J �Gh C1 City of Fort Collins License #0 - ��;g Supervisor Cert # z 3 `
Mailing Address l' Ply City Ll/L � / State (r Zip r>
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
1s' 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: YeNon Energy info: ( Circle appropriate choice ) 1. ComCheck ❑ 2. ResCheck w/Air Sealing 11
3. ResCheck w/Blower Door ❑ 4. Simulated Performance Alternative❑ 5. Prescriptive w/Air Sealing11 6. Prescriptive w/ Blower Doom
City of Fort Collins Stock Plan #
List appropriate option
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes [:]No[:] Temp. Pedestal Yes❑ No
Type of Heat: Gas ❑Electric Electric Main Breaker Size (Residential only) F-1150 Amp or Less 200 Amp DOther
Value of Construction (including labor, material & profit) $'0 / J
Description of Work: L>7i ����(/M(�1 f-1i9/ , 1�GIlil�li'15 3�2 a { I �/p[�tr71'h
': I'w" ( re-_ Y'7rtN11
Contact Name & Phone # of JOBSITE SUPERVISOR: ,��DI Lf�L�AtAe lhlk D2 -6-56 ' 7610
Subcontractor Info:
/Y/CC /
Electrical �1',-4 r- li'1'Gi7 t G
Framer jj4l Roofing_
Solar
Other
Mechanical
Concrete
Other
Plumbing
Fireplace
Other
Applicant: 1 hereby aqnowledge that I have read this application and state that the above information is correct and agree to comply with all requirements
contained herein and of Fort Collins ordinances and state laws regulating building Zstruction. 16,Applicant Signature Print Nameul L't Phone I �5�0 c� 4
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE