HomeMy WebLinkAbout2703 Annelise Way - Applications/Addition or Alteration - 05/11/2012City of
Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
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BUILDING PERMIT APPLICATION
APPLICATION NUMBER 1 —L APPLICATION DATE
Job Site Address 2703 Annelise Way, Fort Collins, CO 80525 Unit #,
PROPERTY OWNER INFO: (All owner Information Is required - It Is not optional) Phone # 970-672-8240
Last name Kettelkamp First Name Timothy Middle Dirk
Street Address 2703 Annelise Way City Fort Collins State CO Zip 80525
CONTRACTOR INFO: Company Name Contractor Phone #
Lic Holder Name
City of Fort Collins License # Supervisor Cert #
Mailing Address City State Zip
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
1n Floor Sq Ft
2n1 Floor Sq Ft
# of Stories Bldg Height # Dwelling Units
3n0 Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths '% Baths # of Fireplaces
Air Conditioning. Ye flN Energy Info: ( Circle appropriate choice) 1. ComCheck 2. ResChec k w/Air Sealing 11
3. ResChec k w/Blower Door 4. Simulated Performance Alternative ❑ 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Doom
City of Fort Collins Stock Plan #
UTILITIES INFO:
Water Tap Size Sewer Tap Size
List appropriate option #s
Metered: Yes ❑Nol--] Temp. Pedestal Yes❑ No ❑
Type of Heat: "Gas "Electric Electric Main Breaker Size (Residential only) ❑150 Amp or Less 200 Amp
�� Other
Value of Construction (including labor, material & profit) $_-3*3@
Description of Work:
Converting portion of the garage into a new mud room, to include washer/dyer hook-up, mud sink and access door for a future deck.
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Contact Name & Phone # of JOBSITE SUPERVISOR: Tim Kettelkamp 970-672-8240
Subcontractor Info:
Electrical Myself Mechanical
Framer Myself Roofing Concrete,
Solar Other Other
Plumbing Myself
Fireplace
1 Ir ,
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 I it s o c id state laws regulating building construction.
Applicant signatur Print Name Timothy D. Kettelkamp phone 970-672-8240
Distribution: Mile —Office Yellow —Applicant Pink —WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE