HomeMy WebLinkAbout216 Tulane Dr - Applications/Addition or Alteration - 01/06/2012City of II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort+t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970.221-6760
wwwAcgov corn/building
�% /�-�J BUILDING PERMIT APPLICATION
APPLICATION NUMBER S J C -'V 0 9� APPLICATION DATE / ✓��
Job Site Address a 16 Tla
Unit #
PROPERTY OWNER INFO: (All owner information is required- it is not optional) Phone # Of /—f _ 0 qd 1
Last name aLIW a /✓ First Name��G d it Middle
Street Address 6/sr!O/1/ & �� j�City FD}fc�OL �iH/S State CCU Zip o 5
CONTRACTOR INFO: Company Name /\ L Lew_5/fC� , Uurr/Contractor Phone #_ 3t0 6Yk-?
Lic Holder Name 191 Kta/,/ wegkr ' City of Fort Collins License # Ca' 6� Supervisor Cert #
q GI Mailing Address f 39 JES tgQQ k S City za)_1�d //, w� State C U Zip_06,15�_a'
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'I Sq
1$' Floor Sq Ft
2nd Floor Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3'd 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)
Description of Work: /( fC h c / . re rn oldal 71Od f'
/1/eGU !l�'�/_G TJ'G tZ4,&JA / amj Niffze/ �I�+G
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontrador Info: ..//
Electrical /'J • K/e c//'i G Mechanical
Framer
Solar
Roofing
Other
Concrete
Other
Plumbing COO -'P114 MOi 6V9
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 oof* JFort
C2X9
nd state laws regulating building construction. L�
Applicant Signature / il(�, Print Name e L 1 Phone �� / J
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE