HomeMy WebLinkAbout3626 Big Dipper Dr - Applications/Basement Finish - 01/17/2012City of I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
FOI t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
/ www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER / t�2 OA-7 Q�� APPLICATION DATE
PROPERTY OWNER INFO: (All owner information is required - It is not optional) Phone #
Last name O.--; / First Name 270, S p/LLI..&A Middle
Street Address, �� _ i e t ,�O R City y t� C ri�l t71S State_e��Zip 9TS.2
CONTRACTOR INFO: Company Name-J96 y � stlf u h ons Contractor Phone # 7 /6 ^63)^3 L%S/
Lic Holder Name dd City of Fort Collins License # -6 Supervisor Cert #,�146%0
Mailing Address.21i1J6/t U 5/� C�A� QrC�D/ City 'F/i l� oJ1 r ii� State C-d Zip 0
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
1 s' Floor Sq Ft
Finished Bsmt Sq Ft
Comm'I Sq
2nd Floor Sq Ft
# of Stories Bldg Height # Dwelling Units
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths 3/4 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
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)
Contact Name & Phone # of JOBSITE SUPERVISOR: -A " I ate 4 �> d -� 3%' .? Sq:S/
Subcontractor Info: "
Electrical T)S '4 Ltti� Mechanical 14R Ai:v-� Plumbing
FramerSj w,a)a y. -t e) goofing
Solar
Other
Concrete
Other
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 7D nfYt /A'yC.Gti� Print Name T &-"g / l t //4*< Phone 1p
9a-63-)'39`
Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE