HomeMy WebLinkAbout2804 Ringneck Dr - Applications/Addition or Alteration - 04/11/2011City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
wwwLfcgov com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER APPLICATION DATE
Job Site Address A R j 4ayier k �ir, Unit #
PROPERTY
//OWNER
II INFO: (All owner Information Is required - It Is not optional) Phone # � 7 oQ 0 _ 0 7 - q 3 (a n
Last name (.rbr K e_+ ' 0 a-k + , First Name SA-5aAq � 1 Middle
Street Address � 9 b y E i�ja e GK h 1^ , City "I-4 . l /h ! I 1 o] S State as Zip
CONTRACTOR INFO: Company Name >'�� . _ T , . „ Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address _ City _ State a 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
15' Floor Sq Ft 2nd Floor Sq Ft 31 Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths '/ Baths # of Fireplaces
Air Conditioning. YeeoNo[] Energy info ( Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing 11
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 ✓I'1
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes RNoF] Temp. Pedestal Yes❑ Nor—] I\�/�
Type of Heat: M Gas ❑Electric Electric Main Breaker Size (Residential only) �150 Amp or Less ❑ 200 Amp Other v J
Value of on)tgtii (iinnccludipg la or erial & profit) S /� 0�'t9 09
�h p S,,�QFFi�t�� i h �c�S h /fir a
Description of Work�j Px1'I �VL ost;+ I oor S u i l 6&-+ WIL-1 1 s r 0 n vcr-- i n 4h, 1, "rGom :.
u�j
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: y J
ctricalT Mechanical
F aam�er��.. Roofing Concrete
01,
Plumbing Cy4La'1
�l 1��► �� r7 J
Fireplace
Solar Other Other 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 Ci of Fort Collins ordinances and state laws regulating building construction. �1
Applicant Signature 00Print Name CSUS" (2 OCJ<t :' - &a4CLPhone 9 %6 -207- 93(p0
Distribution: White - Office Yellow - Applicant Pink - vW WVIStormwater
THIS APPLICATION EXPIRES 180 DAYS OM APPLICATION DATE