HomeMy WebLinkAbout2126 Nancy Gray Ave - Applications/Single Family New - 12/22/2011City of I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
/ www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 7�7N ` ` SC 9 APPLICATION DATE
Job Site Address &\Qsl.o �\(1C1CV
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\�_ Unit #
PROPERTY,( OWNER INFO: (All owner information is required- it is not optional)
Phone #A
Last name _rnPS- 1oI ANC-\ Iy �\\�
irrsst Name
Middle
Street Address t l\
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State�Zip���r�_vY��1
CONTRACTOR INFO: Company Name\\\�&i'CtPontractor
Phone #
Lic Holder Name VtV\
1 _V City of Fort Collins License # `5
Supervisor Cert#
Mailing Address
City
State
Zip
LEGAL INFO:
Subdivision/PUD_ J\d� \M Filing # Lot #�_ Block #C� Lot Sq Ft�
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) \�p p Total Garage Sq Ft
Residential Sq Ft � _ Comm'I Sq Ft a # of Stories_p`:�i Bldg Height&I # Dwelling Units \
1 st Floor Sq Ft
Finished Bsmt Sq Ft
2"d Floor Sq Ft _ 3rd Floor Sq Ft '—
# of Bedrooms _��# o Full Baths �� 3/. Baths
Unfiished Bsmt Sq Ft \ \ �
— '/z 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. Simu a e e ormance ternative' 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan # ��\(�n�\� List appropriate option #s 1i
UTILITIES INFO:
u
Water Tap Size Sewer Tap Size IL r Metered: es or No Temp. Pedestal Yes or No
Type of Heat: Gas ❑ Electric Electric Main Breaker Size (Residential only) �K150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $__ �, �i \-�
of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical QS\ QSQS1 Mechanical R)Q�(1 T\Cl Plumbing
Framer RC�CL,\Q•� Roofing��iU'�lroncrete ��\�\�4 Fireplace
\1�`�t�CY>\�ad�C4
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 City of F Ilin rdin� a�d state laws regulating building construction.
Applicant Signature Print Name Phonepi�Lp\'1
Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE