HomeMy WebLinkAbout613 Brown Ave - Applications/Addition or Alteration - 02/22/2012City 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 O� b APPLICATION DATE �Z&A n
Job Site Address (p%.y /.7racwk i105 ZS Unit #
PROPERTY OWNER INFO:
(All owner information is required — it is not optional) Phone # i �
-70 0 6
Last name �✓� -eJ
First Name /�/efvl% Middle
Street Address / l
613
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City / Cdl/Nf
State C, —Zip D U S ZS
CONTRACTOR INFO: Company Name'' /_ clkl
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� • ti AA,6(G4V�� Contractor Phone #
.Z 1 7 047
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m Lic Holder Nae f c i
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c. l�0. ✓
City of Fort # 0" 6 S
Supervisor Cert # Z`06 '7 N P
Mailing Address /�01
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�License
/ tCCollins
L4 f City / f/ 1:Ct�/ hs State �� Zip CJ Z
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 Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths /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. 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) $ (- �/
Description of Work: 6 7 `O v G � R ,e xAc deq /Kr f C -t"
Contact Name & Phone # of JOBSITE SUPERVISOR: �P S r 5 6.i ram,/ Z l 7 - 0 /
Subcontractor Info:
Electrical /a 0" C.a r-r5 k �tJC.1-r5 k ,eJ / Mechanical _
Framer A /(. r- Roofing
Solar
Other
Concrete
Other
Plumbing P s'^ e ► ►S YK t
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 Fo ollins ordinances and state laws regulating building construction. 7 G
Applicant Signatureg�� � Print Name &r, r 9 (- k. �/ Phone 2 / 7 - 0 /O %
Distribution: White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE