HomeMy WebLinkAbout1833 Golden Willow Ct - Applications/Gas - Log, Line, Pipe - 07/23/2012City of Planning, Development & Transportation
281 N. College Ave P.O. Box 580
FOrt Collins Fort Collins, CO 80524
`- Phone 970-416-2740 Fax 224-6134
OVER-THE-COUNTER PERMITS ONLY
This application is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter KGas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applica le information on the a�p%p ication.
Application # . ZAld
For o ice use only
Incomplete applications will not be accepted.
Date 7tz3.11Z
Job Site Address (required) Value of Construction (labor, materials, profit)
183.3 G � oo pO
owe � e-
Property Owner Name
Address
City/State Zip
Phone
Applicant Name
Address
City/State Zip
Phone
1& t+ Aii"re.SLY
S. viz
�- �,s osZ l
?70 lZ�io u
Contractor Lic #
Address
City/State Zip
Phone
sor
C4.—
Contractor City of R. Collins Sales Tax #
Are you paying taxes here or by report?
IKHere ❑ Report
Sales tax number isrequired byall contractors.
Are you paying with your trust account?
❑ Yes ❑ No
Is this a residential or commercial project? 6Residential ❑ Commercial
If residential, is it: a Single Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar ❑ Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes a�No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed?
lfpr/or to 1975, you will need an asbestos assessment to submit with this application.
Description of work &!!!g .,&,v CO-S a ,jL w �,, PST •
*If lawn sprinkler/backflow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician.
Subcontractors: List the company name or City of Ft Collins license #
Electrician AfrAl f Plumber& ler h'Ad (mechanical ✓ /Q Roofer .r/z/¢ Other ✓ 4f
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction. I know that a
permit is not valid until it has been paid and issued.
Applicant: J
Print Name:.57zWC_ It4., r.Jb--- Signature
Date %•23•% Z
City of II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Forrt Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
/ wvvw.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER / r�-O / � APPLICATION DATE � 23 — /o9--
Job Site Address
1833 Golden Willow Ct. Fort Collins, CO 80528 Unit #
PROPERTY OWNER INFO: (All owner Information Is required - It Is not optional) Phone # 970-449-2002
Last name Peters First Name Brent Middle
Street Address 1833 Golden Willow
CONTRACTOR INFO: Company Name
Lic Holder Name Dwight Sailer
City Fort Collins state CO Zip 80528
HighCraft Builders Contractor Phone # 970-472-8100
Mailing Address 429 S. Howes St.
LEGAL INFO:
Subdivision/PUDWillow Springs
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'I Sq
11 Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
City of Fort Collins License # D-597 Supervisor Cart # 1288-D1
_ City Fort Collins State CO Zip 80521
Filing # Lot # 77 Block # Lot Sq Ft 8490
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths Y2 Baths # of Fireplaces
Air Conditioning: Ye�]NoH 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 Doom
City of Fort Collins Stock Plan # List appropriate option #s �Q
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes []No[:]Temp. Pedestal Yes❑ No ❑
Type of Heat: ❑ Gas Electric Electric Main Breaker Size (Residential only) F-1150 Ampor Less ❑ 200 Amp DOther
Value of Construction (including labor, material & profit) $ 65V �
of
Contact Name & Phone # of JOBSITE SUPERVISOR: Steve Warning iW-2939
Subcontractor Info:
Electrical Mountain & Plains Mechanical
Framer RW Builders
Solar
Roofing
Other
Concrete
Other
Plumbing ' kn " 'O n iC s
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 Fortfins ordinances and state laws regulating building construction.
Applicant Signature Print Name JtR.Aav 1Z-13 ccr- Phone 970 -y ? a-8/b0
Distribution: White -Office Yellow -Applicant Pink - WWW/Stonnwater
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