HomeMy WebLinkAbout1644 S College Ave - Applications/Addition or Alteration - 02/28/2011City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rt Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER �.J 11 OV�� APPLICATION DATE a601
Job Site Address
Unit #
PROPERTY OWNER INFO: (All owner inforrpation iis,�required - it is not optional) Phone #
Last name, In1 �`FRst Name � Middle
Street Address A\R— City '��(� \ Pj��T1(i5 State���
CONTRACTOR INFO: Company Name Contractor Phone # �(� � (�
Lic Holder Name (( Y ,ICity of Fort Collins License #��� Supervisor C
LEGAL INFO:
Zip
�/
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Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
ert #
Mailing Address 4 '' � 4 City � O I State v Zip � t
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm] Sq Ft,
111 Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3'd Floor Sq Ft
# of Bedrooms # of Full Baths 3/< Baths
Unfiished Bsmt Sq Ft _
'/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
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) $ 20 K.
Description of Wo
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: %
Electrical V Mechanical
Framer
Solar
Roofing
Other
Concrete
Other
Plumbing Ot0 - plwx"
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 Ci of Fort Collins ina s and state laws regulating building construction. /
Applicant Signature Print Name Lfo ulstna— Phone V0 'awl -0m
Z1_ CN?--,
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater X 3 j _
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE