HomeMy WebLinkAbout5615 Northern Lights Dr - Applications/Single Family New - 02/14/2014COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: +970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER W APPLICATION DATE
Job Site Address -% 15 N �rrnL-aAd�? I)YA-S i Unit #
PROPERTY OWNER INFO: (All owner information is required- it,iis�not optional) Phone # 910, 2-32 t � zw
Last name C.Utc� t fYN �,� First Name yyA0,C:1��/�- Middle U�
Street Add ress � 1 Gyo ,,K N rnyl)z � City t CJy I.PJ` l t�5 State CO Zip p�+'�/
CONTRACTOR INFO: Company Name 1�Lar'6 LJ�J �A� Contractor Phone # � 2- ' -[-1. O
Lic Holder Name C-� OCity of Fort Collins License # Supervisor Cart #
Mailing Address `^GG Gt)o nvC City.
LEGAL INFO:
State
Subdivision/PUD 1 tej- — I 6eJS C Filing # Q3 Lot #� o Block # ^t Sq Ft��
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) 9 31 Total Garage Sq Ft �S t IZD
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height 0?x # Dwelling Units
11 Floor Sq Ft 19 31 2nd Floor Sq Ft N Ac 3rd Floor Sq Ft
N Ac
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths 2 '/< Baths '/z Baths # of Fireplaces 1
Air Conditioning: 0-No Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4._Skaufated Performance Altern ive - 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan # �� 3 �3� List appropriate option #s
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal Q or No
Type of Heat: Gas ❑ Electric Electric Main Breaker Size (Residential only) x50 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit)
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: / _ 1,�}-�
Electrical [.- vy, , h��Mecchanical 1 601- V\V y�F-t"�� 'nG/ Plumbing
Frame�760� aCr ` Wo" Ping 806 17e� S Concrete 1Jy�U� GOVA�replace*;2��':fyMi!?
Solar N A' Other Other Other
Applicant: I hereby acknow6thal ve re this ap icati an state that the above information is correct and agree to comply with all requirements
contained herein and City ordinanc n to I tllating building construction. 11e
Applicant Signature rint NameA�'��-R U� J Phone0a0` 2?J2`CtS 4
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE