HomeMy WebLinkAbout704 Mathews St - Applications/Accessory or Secondary Building - 09/29/2011City of
II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Flirt Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 0 SDbof APPLICATION DATE Ll r2:
Job Site Address ��='�L� �"'l auk ST Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 9 210— il!23-0 Rs%9
Last name ,�1�damn, First Name H AtL Middle A
Street Address %O�t a *1- kj5 City E1, State_go _Zip �OSa y
CONTRACTOR INFO: Company Name ;sica Contractor Phone #
Lic Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
City of Fort Collins License #.
Filing # Lot #.
Supervisor Cert #
State
Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft ot!�010
Residential Sq Ft
15' Floor Sq Ft
Finished Bsmt Sq Ft
Comm] Sq Ft # of Stories Bldg Height # Dwelling Units
Air Conditioning: Yes 0
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
20d Floor Sq Ft
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths Yz Baths # of Fireplaces
Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
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) $ 10, eny I
Description of Work: tM(Le �- P�� I/NLr�y�� ND GJf- sriV��
Contact Name & Phone # of JOBSITE SUPERVISOR: S�C.J-F- ! o- eo 10 -B5'g
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
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
//off��Fort Collins ordinances and state laws regulating building construction.
Applicant Signature "�L�. Print Name h Sa'l Phone "l %G C90 A-249
Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE