HomeMy WebLinkAbout120 N Roosevelt Ave - Applications/Addition or Alteration - 06/17/2011City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 Phone: 970-221-67
www.fcgov com/building q00
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 40i C7/J1 UGU APPLICATION DATE
Job Site Address I20 Al K-®�����_ Unit #
7:bf-�T- Coat-1 AK, co 60 S1I `
PROPERTY OWNER INFO:
•(All 'owner information is required- it is not optional) Phone #
Last name 6 F6 t ` ! First Name 6 LIL% rMiddle
Street Address 1Z?% VV �5� / �ea&/C City fbC �6 W 4fl State—C."o Zip 90 15-Z4
•CONTRACTOR INFO: Company Name/gf Contractor Phone #
Lic•Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address City.
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total B
Residential Sq Ft Cc
V Floor Sq Ft
Ft (not including
2nd Flog1F Sq Ft
Finished /w/Blower
t # of
Air CondYes No
3. ResCh Door 4. Si
City ofiFort Collins Stock Plan #
UTILITIES INFO:
info:
Water Tap Size Sewer Tap Size
State Zip
Filing # Lot # Block # Lot Sq Ft
Total G
# of St es Bldg Height # DwLen3rd Flo r Sq Ft Unfiished B# f Full Baths 3/4 Baths '/2 Baths #;/e appropriate c ice ) 1. Com eck 2. ResCheck wce Alternative 5. Prescri lve w/Air Sealing 6. Pre
List aD ropriat otion #s
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: Di� lo> fit/ d r
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Mechanical
Roofing !!�EIS7 Concrete
t
CeliilM
Other
Plumbing
Fireplace
Other
r Door
Applicant: I hereby acknowledge that I h e read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort Coll' ordinance, d s regulating building constru�ctjion. �"J�
Applicant Signature Print Name / Phone 9� 6Z
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE