HomeMy WebLinkAbout5 Old Town Sq - Applications/Patio Cover Or Sun Shade - 03/29/2012City
{of I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rCollins 281 N. College Ave. • Fort Collins, CO 86524 • Phone: 970-416-2740
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER S/ `&Qj�bC) APPLICATION DATE `2�
Job Site Address. - c c y7 :Srx6;e4,e_ Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone
Last name First Name Middle
Street Address City State Zip
CONTRACTOR IN-7
F^O:-Company Name PC jQCSC a /AtfnS />'t�Contractor Phone #'iZ4, ` e? 3-mod 3 3
Lic Holder Name i / /n� �il/vsrr, /� ^ City of Fort Collins License #A::�" Supervisor Cent #
Mailing Address City ��. �l�i�n State Zip5,05;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 cO 0 # of Stories Bldg Height # Dwelling Units
161 Floor Sq Ft
2na Floor Sq Ft
31 Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths 3/, Baths 1/2 Baths # of Fireplaces
Air Conditioning: YeGoR Energy info: ( Circle appropriate choice ) 1. ComCheck ❑ 2. ResCheck w/Air Sealing ❑
3. ResCheck w/Blower Door ❑4. Simulated Performance Alternative❑ 6. 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 ONoo Temp. Pedestal Yes[] No ❑
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) 1:1150 Amp or Less ❑ 200 Amp Other
Value of Construction (including labor, material & profit) $ / 7 g�
Contact Name & Phone # of JOBSITE SUPERVISOR: 11,01
Subcontractor Info:
Electrical 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./� �/q
Applicant Signatu— `/� Print Name r . I- L_a✓YYi APhone L L
Distribution: White -Office Yellow -Applicant Pink - WVWV/Stormwater
THIS dAPPLOCdAT50I,l EXPIRES 180 DAYS FI1PaM APPLICAtl90 M DATE