HomeMy WebLinkAbout2504 Constitution Ave - Applications/Addition or Alteration - 08/06/2014COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
City of
Fort Collins
APPLICATION
+Job Site Address
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970.221-6760
www.fegov.com/building
BUILDING PERMIT APPLICATION
APPLICATION DATE 2i- 0 ' [ q
Unit #
S�PROPERTY OW''AANER INFO: (All owner information is required - it is not optional) �Ph�one #
Last name �.Vl� First Name �Vom" Middle AFL
Street Address "[�✓y`i NWq r/1 K 4'�/ yy����C,i�ty T A) II I (iUI�WfV /�Sta/t�e p� ./Zip
CONTRACTOR INFO: Company Name AS Contractor J rdUV Contractor Phone #. Ly `t 1 -10II
Lic Holder Name
Mailing
LEGAL INFO:
City of Fort Collins License # Supervisor Cert #.
State Zip.
Filing # Lot # Block # Lot Sq Ft
Total Building Sq Ft (not including basement) T
Residential Sq Ft \Comm'I Sq Ft # of Stories
11 Floor Sq Ft
Finished Bsmt Sq Ft
Air Conditioning: Yes No
3. ResCheck w/Blower Door 4.
City of Fort Collins Stock PI _
UTILITIES INFO:
Ft
# of Bedrooms
Energy iJfd. ( Circle
3rd FJDefSq Ft
a1.Ggrage Sq Ft
# Dwelling Units
Unfiished Bsmt Sq Ft _
Baths % Baths /z Baths # of Fireplaces
Performance Alternative
) 1. ComCheck 2. ResCheck w/Air Sealing
'Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
List appropriate option
Water T ize Sewer Tap Size Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
+Value of Construction (including labor, maatyerriiaally& pprrofit)),-$1_
Description of Work: I1-07 $
.n
Contact Name & Phone # of JOBSITE SUPERVISOR: 1 ,1/V -`0IO 1 W 1 I
5
3ubcontractorInflo:: - b
Electrical IM J��1�r�M'Pj/i���/�/ AA Mechanniic/al��lT� Pf a Plumbing (r 1 1Pt144
Framer V � 5IN 1 Gr 1J1 'W -ofing A y 0 G A/►1 • Concrete ire ace W ry
r
Solar
Other
Other
Other
Applicant: I hereby ackn wledge that I have read this application and state that the above information is correct and agree to comply with all requirements
contained herein and i f Fort Coll, ,i' c and state laws regulating building construction.
*pplicant Signature Nlj Print Name Phone l f 011
Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE