HomeMy WebLinkAbout2133 Sandbur Dr - Applications/Single Family New - 02/15/2011(F/' io
City of Fort Collins
APPLICATION NUMBE
Job Site Address
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
' /90(9./ ' \ APPLICATION
Unit #
- it is not optional) Phone #Lo
Last Name First \N`amme\_
Street Address �i` �GSc�C�('1V R' #
CONTRACTOR INFO: Company Name
Middle
Cityx�'� \C StateM_Zip!Q yB
Contractor Phone #
Lic. Holder Name Z)yCLy\\m \I P�\m4S City of Fort Collins License #D�_ Supervisor Cert #Q65\_
Mailing Address
City
State Zip
LEGAL INFO:
Subdivision/PUD\c1�,(]\�� Filing # `` Lot # Block #� Lot SCjq
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) 1�LA? > Total Garage Sq Ft
Residential Sq Ft � Comm] Sq Ft # of Stories Bldg Height # Dwelling Units
1st Floor Sq Ft �dJ�n� 2nd Floor Sq Ft Unfinished Bsmt Sq Ft�_ Finished Bsmt Sq Ft
# of Bedrooms # of Full Baths 3/4 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. E-Star w/Blower Door 1 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # \1\- a List appropriate option #s
UTILITIES INFO:
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Water Tap Size '-.- Sewer Tap Size \A 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) $ \� , - I
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Description of Work: ' is ca\ C_ N-V -Ic 1C� � C Rmt! C� , F 25\ ckc& (y r crt Cn
Contact Name & Phone # of JOBSITE SUPERVISOR: C�tRS1\Q_�i rC1 CT1e� l��\"'
Subcontractor Info:
Electrical ���5� ('\ Mechanical Plumbing �C�� Qcj�\C��\
Framer Roofing ��] Q��t'1� ���1 Concrete , Other
Applicant: I hereby ac nowledge that I have read this application and state that the above information is correct'and agre -tb comply with all requirements
contained herein and City of Col' ordinances and state laws regulating building construction. Q 2
Applicant Signature Print Name �\ ` Phone01
Distribution: White - Office Yellow - Applicant Pink - W W/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE