HomeMy WebLinkAbout2830 Sombrero Ln - Applications/Addition or Alteration - 03/05/2012City of II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort+t Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
/ www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER —T� 1 '20 ( APPLICATION DATE ",j — I,) -
Job Site Address 2$W Unit #
PROPERTY OWNER INFO: (All owner Information is required - It Is not optional) Phone #
Last name 01'sov, First Name 4 d-. Middle Dmv.4
Street Address Z%30 [411.4- City �cir �� �� ^s State CO' Zip 60L; ZS
CONTRACTOR INFO: Company Name
Lic Holder Name
Contractor Phone #
City of Fort Collins License # Supervisor Cert #
Mailing Address City State
LEGAL INFO:
Subdivision/PUD jMtc44wS Ea5k
Filing # Lot # 138 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
2nd Floor Sq Ft
3" Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths Y: Baths # of Fireplaces
Air Conditioning: YeGo0 Energy info: ( Circle appropriate choice ) 1. ComCheck 1:1 2. ResCheck w/Air Sealing 11
3. ResCheck w/Blower Door ❑4. Simulated Performance Alternative11 S. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
List appropriate option
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes E]NoEl Temp. Pedestal Yes❑ No El
Type of Heat: ❑ Gas1-1 Electric Electric Main Breaker Size (Residential only) �150 Amp or Less 200 Amp Other
Value of Construction (including labor, material & profit) $ ZCJ CM
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR: P k 04c-, 170- 237 - 1$1 y
Subcontractor Info:
Electrical Mechanical
Framer Roofing
Solar Other
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowledge t at !Jiave read this application and slate that the above information is correct and agree to comply with all requirements
contained herein and City of Fort -Ws ordipdqces and state laws regulating building construction.
F-t
Applicant Signature Print Name i* 0I3,01^ Phone g7() "237-lPLj
Distribution: White - Office Yellow - Applicant Pink -vW W/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE