HomeMy WebLinkAbout722 W Mountain Ave - Applications/Addition or Alteration - 03/05/2012Fort Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6k6o�o
www.fcgov.com/building J
BUILDING PERMIT APPLICATION 1,3
APPLICATION NUMBER `��// APPLICATION DATE
-kJob Site Address-11,fZ, W N\'IVV r-)P\V DVV, Unit #.
'PROPERTY OWNER INFO: (All owner Information is required - it is not optional) Phone #
Last name �1NVAg n ' `tV First Name 1IO��_ 1 ' , Middle
Street Address -1 Z�J w 't , I „r ° ly% City � 66�1XV� State�Zip�
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm] Sq
161 Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
Contractor Phone
City of Fort Collins License #.
City.
Filing # Lot #
Supervisor Cert #
State Zip
Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths '/. Baths Y2 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:
Water Tap Size Sewer Tap Size
Type of Heat: ❑ Gas ❑ Electric Electric Main
List appropriate option
Metered: Yes or No Temp. Pedestal Yes or No
(Residential only) ❑ 150 Amp or Less ❑ 200 Amp []Other
Value of Construction (including labor, material & profit�-E " . -1 - '
Description of Work: �yyle C'�� elomn&50 'ro
Contact Name & Phone # of JOBSITE SUPERVISOR:
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 of Fol Collins ordinances and state laws regulating building construction. //' `�QQ 2q
VApplicantSignaturePrint Name �� Phcl;;i �OQ f/1�
Distribution: White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE