HomeMy WebLinkAbout3800 Dahlia Ct - Applications/Addition or Alteration - 02/10/2012City of
I COMMUNITY DEVELOPMENT &NEIGHBORHOOD SERVICES
�t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970.221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER I2, QV L1/ 1 gAPPLICATION DATE Feb. D i �.
Job Site Address 31 po [)a h a Co u r+ Unit #
orb- Lo(I.A!5, Ca % 0 15 -2,16'/
PROPERTY OWNER INFO: (All owner information is required - it isnotoptional) Phone # ciJ% o 114 o a -'q50 5-
Last name 61 ar,k1w-e/u- FirstName Middle
Street Address iJ 3 rl i VP,t- (iV f1j (/�w
� City V I YLG� '5 0 r' State_if_0Zip D 5 J &
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
Contractor Phone #
City of Fort Collins License # Supervisor Cert #,
State
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
161 Floor Sq Ft
2nd Floor Sq Ft
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished 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) $ —M4�• 90
of Work: 44,4.tr ,
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor f4 rInfo:: nn
Electrical o 1'�W►ex, Mechanical
Framer
Solar
Roofing
Other
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 of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature ?rCQCKu Print Namehel( Vj31Q.c kyteAj Phone q10q'o;2 2'S65
Distribution: White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE