HomeMy WebLinkAbout4160 Sumter Sq - Applications/Addition or Alteration - 04/04/2011I
City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER_le /
T APPLICATION DATE
Job Site Address (o 0 5UM-6 - -ra Unit # PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 170 - 7,7-5--2-9 c ` 7
Last name W 1 �,GOG-- First Name 6-4Wy-4 Middle f ,
Street Address "L L 0 Sum-tleK ire City 1 r ` (fw N II -5 State 60 Zip ®�Z
CONTRACTOR INFO: Company Name �� Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Add
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not
Residential Sq Ft Comm'I Sq
1 st Floor Sq Ft
Finished Bsmt Sq Ft
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
2nd Floor Sq Ft
City
Filing # Lot #.
State Zip.
Block # Lot Sq Ft.
ng basement) Total Garage Sq Ft
# of Bedrooms # of
# of Stories Bldg Height # Dwelling Units
3rd Floor Sq Ft
Energy info: ( Circle appropriate 1
4. Simulated Performance Alternative
List appropri
Unfiished Bsmt Sq Ft
3/< Baths '/2 Baths # of Fireplaces
1. ComCheck 2. ResCheck w/Air Sealing
Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
#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) $
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: Electrical r Oia Mechanical C i2�F Plumbing �o e� p
Framer Isec Roofing Concrete 50Fireplace
Solar A) V Ike Other Other 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 Fort Collins ordinances and state laws regulating building construction. /�
Applicant Signature_a Print Name �a Uf f l GOC-� Phone 770` G ell-1 6 74-
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE