HomeMy WebLinkAbout2620 Marshfield Ln - Applications/Basement Finish - 06/18/2012COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER W `# APPLICATION DATE C I' D
Job Site Address dk,20 6rrsb4'eld Lprw_, Unit #.
PROPERTY OWNER INFO: (All owner informati n is required- it is not •optional) Phone # 970 69ol ",� lS
Last name 1N- r /First Name W) �I !Q wl / Middle T
Street Address ( City -) iy- (foulns StateCDZip
CONTRACTOR INFO: Company Name
Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cert #.
Mailing Address City State Zip
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units _
16' Floor Sq Ft 2n' Floor Sq Ft 31d Floor Sq Ft Unfiished Bsmt Sq Ft _
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths I 1/4 Baths '/z Baths # of Fireplaces
Air Conditioning: Yes No Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
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 #
UTILITIES INFO:
List appropriate option
Water Tap Size 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, material & profit) $ r O�i
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: {'
Electrical 6VI E6jr;C Mechanical
Framer
Roofing
Concrete
Plumbing
Fireplace
Solar Other. — Other Other
Applicant: I hereby acknowledge that I e re this application and state that the above information is correct and agree to comply with all requirements
contained herein and City off Ili anstate laws regulating building construction.
Applicant Signature Print Name Y Phone q7O &Yb
»5a
Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE