HomeMy WebLinkAbout506 Nokomis Ct - Applications/Addition or Alteration - 05/29/2014Fort Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
wwwfcgov.com/building Fee V42•V5
BUILDING PERMIT APPLICATION
APPLICATION NUMBER tl )1 4OVW 23 APPLICATION DATE
Job Site Address 506 i10 key%,S 6 f 9-O 2 I-1 Unit #
PROPERTY OWNER INFO: (All owner information is required — It is not optional) Phone # (q 70) qkl-38�l
Last name V).g s f,_Om First Name Ti A. -I Middle Gy"�
Street Address 5-06 Arekv�n'S 6, City FS State Zip ��`I
CONTRACTOR INFO: Company Name
Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address City State Zip
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including
Total Garage Sq Ft
Residential Sq Ft I Z-9'd Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
15' Floor Sq Ft 750 0 2nd Floor Sq Ft ✓ 3 H W Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms 3 # of Full Baths 2 '/. Baths /z Baths # of Fireplaces
Air Conditioning: Yei&n Energy info:( Circle appropriate choice) 1. ComCheck ❑ 2. ResC heck 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 #
List appropriate option #s
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes []No[] Temp. Pedestal Yes❑ No ❑
Type of Heat: [A Gas ❑ Electric Electric Main Breaker Size (Residential only) E-1150 Amp or Less ❑ 200 Amp 0Other
Value of Construction (including labor, material & profit)
Description of Work: add?
f L~,-il
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Mechanical
Framer Roofing Concrete
Solar Other Other
Plumbing
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 9Eqpances and state laws regulating building construction.
Applicant Signatu Print Name Gam-+- r f S Phone `.'?70)
Distribution: White — Office Yellow —Applicant Pink — VWVW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE