HomeMy WebLinkAbout2619 Raintree Dr - Applications/Deck - 10/26/2011City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rtCollins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
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Z1 •�� BUILDING PERMIT APPLICATION J-9.0
APPLICATION NUMBERT'j 691 �� APPLICATION DATE O. (hY
Job Site Address y �4 " Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name �I Vim' tP'�jFirst Name Middle
Street Address �r�� �Cp f/?�'``�e Cite`''y ��`� ��`���-S StatZip z
7 It
CONTRACTOR INFO: Company Name e licbl`e Cf�i2S-fnuc#r�►'t • Contractor Phone # y�3 76y — %Z
Lic Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address/,5��5 S �''?1-i2� 1— 41 �' �f ',312- city d ��`�`e State lLS Zip l -C> 4 Z
LEGAL INFO:
Subdivision/PUD
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total ilding Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft , `C m'I Sq Ft # of Stories Bldg Height # Dwelling Units
1It Floor Sq Ft
2"d Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished 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
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) $ l� •�y
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
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 City of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature Y' Print Name 5v� V . 1 � i f-. t I't Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE