HomeMy WebLinkAbout2713 Sagebrush Dr - Applications/Deck - 04/19/2011City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rtCollins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fegov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER / �/ APPLICATION DATE Z-/ //
Job Site Address /r��x�g6. ? r' Unit #
PROPERTY OWNER INFO: (All owner information is required -it is not optional) Phone # 719-b wo:(i ~ 5 /D4f
Last name First Name D 1+CJ6 4_yA, Middle
Street Address 1 `` f- City f ' ./I �1i ti' State_�_Zip�
CONTRACTOR INFO: Company Name &t_4_ 1 ww-4 ,S �' vim\ Contractor Phone # eI "'-cis
Lic Holder Name Lr)k_1`an . City of Fort Collins License # j) -i� 9 a_ Supervisor Cert #�
Mailing Address (�, �ta CAA x22 W 15V City 1'�. G State 60 Zip 3�
LEGAL INFO:
Subdivision/PUD
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement
Residential Sq Ft Comm] Sq Ft_
15' Floor Sq Ft
Finished Bsmt Sq Ft
2°d Floor Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/2 Baths # of Fireplaces
Air Conditioning: Yes No Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing M
3. ResCheck w/Blower Door 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door I�I
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) $
Description of Work: `ev. • "V e'y e;Z qO JCL b�_G 14 .2 -6,,A 1 � I C?G.
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
7qqfj�9
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 City of Fort Collins ordi laarXs ate laws regulating building construction.
Applicant Signature Print Name 1PY 2LV-5 Phone *4
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE