HomeMy WebLinkAbout4500 Vista Dr - Applications/Reroof - 05/01/2012City of I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
/ wvwKfcgov com/building
` RBUILDING PERMIT APPLICATION
APPLICATION NUMBER �1 �D Vlt_P� APPLICATION DATE �— ,— ( Z
Job Site Address L/Soo V, s A. D., vUnit# w�A
PROPERTY OWNER INFO: (All owner information is required - It is not optional) Phone # 70 - 1 9 It o g S g
Last name &Pe / ser- First Name k- oK // / Middle
Street Address SOU V/-' City ` (•�s State CC) Zip SIUS26-
CONTRACTOR INFO: Company Name Contractor Phone # 17% — 3 7 Z - y?
Lic Holder Name �Zo y P / L�a c k City of Fort
Collins License # Supervisor Cert #
Mailing Address �3 g C' S �'* S �" ^ City "�f -f State ed Zip �Z g
LEGALINFO:
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] Sq Ft # of Stories Bldg Height # Dwelling Units
Is' Floor Sq Ft
2n° Floor Sq Ft
3id Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths % Baths # of Fireplaces
Air Conditioning: Yer]No0 Energy info: ( Circle appropriate choice) 1. ComCheck11 2. ResCheck w/Air Sealing 11
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 # List appropriate option #s
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes []Non Temp. Pedestal Yes❑ No ❑
Type of Heat:11 GasElectric Electric Main Breaker Size (Residential only) 0150 Amp or Less ❑ 200 Amp DOther
o_
Value of Construction (including labor, material &profit) $
Description of Work: k e M cry e /- do P lq c e /Qo o T_
Contact Name & Phone # of JOBSITE SUPERVISOR: ?, 9 u "el, & % 7u -
Subcontractor Info:
Electrical
Framer
Solar
Mechanical
Roofing /VIA Concrete
Other
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 Fo ns or s and state laws regulating building construction.
Applicant Signature `- L Print NameIfle/ 6(ol c LL Phone q%a- 37 2-i 17?1
Distribution: White - Office Yellow -Applicant Pink - WWW/Stonnwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE