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..} �^ ! COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
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BUILDING PERMIT APPLICATION
APPLICATION NUANWrr � I � t J S 3 l C;L APPLICATION DAT O 1 U-4-LI
Job Site Addttiia4s jig,20 Gress 'W Unit #
J2QeEM0V0lERlN1F_Q:_ (AU owner inlon soon is requbed - hie not opowel) Phone # - 1 Z
Last name First Name LCt LvVa Middle
Street Address L(V-0 CM04 pin-) City, t�rk pilirnS State�zlP .
Company Name Grob( Zofh- Contractor Phone # Giro 5q 3 3o2 p
Lic Holder Name City of Fort Collins License # Supervisor Cart #
Mailing Address W��( E. s✓ ,sea,.l o e• t3iud city (.cue jcw.o� state CA zip Mr.
SubdlvlsionlPUD Firing a Lot # Block # Lot Sq Ft
cghl=CTION INFO--- Total BUriding Sq Pt (not Induding baseman) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft 0 of Stories Bldg Height # Dwelling Units
Is Floor Sq
2n° Floor Sq
3i4 Floor Sq Ft
Unfilshed Bsrnt Sq Ft
Finished Bsmt Sq Ft 0 of Bedrooms # of Full Baths V4 Baths % Bathe # of Fireplaces
Air Condldonlr4 Ye l EnwW Ink-( GWe app!apnafe choice) 1. ComCheok c) 2. ResChack w/Air Sealing
3. ResCheck wA8Jw r Door F
4. Simulated Performance Altemativea S. Presaiptfire w/Atr Sealing 11 , a. Prescriptive w/ Blower DOOO
City of Fat Collins Stook Plan # List appropflate option ft
Water Tap Size aewerTap Size Motired:Yes ❑No[:] Temp. Pedestal YesElNo❑ .
Type of Heat Gas ❑Elo&c Electric Main Breaker Size (Residential only) E]150 Amp or Less 11 2DO Amp DOther
Value of Constriction (including labor, material & profit) $ /Zt OD q 55.E ' 17_
Description of Work: _Qe.t2nat r d.- 93eplao, Rwf wry 1 Q 5k: 14s, gsoy
r
Contact Name & Phone # of JQBSITE SUPERVISOR: CT� L407, 3 SZZ-
ElecMcal Mechanical
Framer
Solar-
Roofing
Other
Applicant I hereby acknowledge tho I have
contabied herein and City of Fort CoNns co
Applicant
Plumbing
concrete Fireplace
00W Other
and atate that the above information is arrant and agiss to comply with all requiremante
9 regulating building oontabucNon.
Print Name .b&A ft,fn�-IS Phone -�07� 35Z=-
Otflce Yellow -Applicant Pink-WWW/Stomwater