HomeMy WebLinkAbout6005 Mars Dr - Applications/Basement Finish - 11/17/2011City 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
II
APPLICATION NUMBER
APPLICATION DATE
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Job Site Addresses
M(�I,_� f ,l��r). St��Z� Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name r Mu"hQ
'Z First Name t7�gt d A Middle
C%I 11 A b State—CQ--Zip 6 Z
Street Address 6 it m
May., Dr C'. City—jectek
CONTRACTOR INFO: Company Name Contractor Phone #
City of Fort Collins License # Supervisor Cert #
Lic Holder Name
Mailing Address
City State ZIP
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 3'd Floor Sq Ft Unfiished 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. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
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: �4 Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp []Other
.00
Value of Construction (including labor, material & /profit) $ 100 1 oO
Description of Work: �ICII��� `O� �a����—r��� 5
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Contact Name & Phone # of JOBSITE SUPERVISOR: 9 70 2 IS- U SwI ? P�t.l�
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
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 Cit of Fort Coll' s o dinances and state laws regulating building construction. f
Applicant Signature '
Print Name l lwj ✓'7-lV[� Phone U-Z!Y-
Distribution: White -Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE