HomeMy WebLinkAbout4816 Regency Dr - Applications/Deck - 10/25/2011City of
Fort Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80522.0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER Z-&//D 942 APPLICATION DATE
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Street Address g p(�phL (��('i City t—.r, C-d �l i 1'1,StateM Zip
CONTRACTOR INFO: Company Name Contractor Phone #
Lic Holder Name
Mailing Address_
LEGALINFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
City of Fort Collins License #_
City
Supervisor Cert #
State Zip
Filing # Lot # Block # Lot Sq Ft_
Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3r1 Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths 3/4 Baths /z 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&
M
City of Fort Collins Stock Plan # List appropriate option #s
UTILITIES INFO:
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) $ 4*'' t D
Description of Work: l l oV'Ir% A 14 In e21Ar ANfA 1 Pki < i
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
G
Plumbing
Fireplace
Other
0
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 ity of Fort Collin rdinances and fate I v s regulating building construction.. �p Q
Applicant Signature Print NamQ�)L 1`�P k / ► L y A k� 5 Phone 7 qTP ✓ 2 `
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THOS APPLOCATBON EXPURES 180 DAYS FROM APPL@CATION DATE