HomeMy WebLinkAbout120 W Laurel St - Applications/Shed - 06/22/2011COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
City of
F6rt Collins
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER k_)� I V APPLICATION DATE
Job Site Address g-,Q ' !2 L a xreA s�'. FOV+ Ca 1l �'h5 Unit #
`�05)-'t
PROPERTY OWNER INFO: (All owner inf rmation is required — it is not optional) Phone # a'10
Last name W'%\�cQld'(15 FaMityM ner5Vh P First Name Mo.a�C'NeLVWV'1_5 Middle
Street Address 1� 0�2 ) ; (QR Ix�Q� City fD-(4- C t/w ns State C O Zip 90�_
CONTRACTOR INFO: Company Name ��LiAexis (1 % 'a\d4 Contractor Phone # 340864 s3
Lic Holder Name City of Fort Collins License # G (Q5 Supervisor Cert #
Mailing Address ��+ CitState zip
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'I Sq
1It Floor Sq Ft
2nd Floor Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
31d 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) $ 1-D 00 - 00
Description of Work: G
sy\e�d ( (o' 2 X q, G") o -
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Mechanical
Plumbing
Roofing Concrete Fireplace
:)OC4-
Solar Other Other Other
i
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 Print Name A{ IKLL� f1&' K4 ? Phone —b
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE