HomeMy WebLinkAbout4331 Mill Creek Ct - Applications/Addition or Alteration - 07/07/2012City of I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES,/
FOIrt Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760 t2icP7
/ � www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 6I ;2 0 7 dD APPLICATION DATEt I.
Job Site Address y331 vv\ 1� C&sg 1Z Cl—. Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name m �'1:� $ First Name t_l f� t<//L� Middle
Street Address �C 3 3 l MA I Cie f F �� C'. City i-��,7- C0 �,tt$ State CO Zip/- Qj"
CONTRACTOR INFO: Company Name C0,31. Contractor Phone
Lic Holder Name
Mailing Address
LEGAL INFO:
City of Fort Collins License # D 3 IC/ Supervisor Cert #
_ City Lcgul IWA_t�> State Zip Y Os'>�7
Subdivision/PUD Filing # Lot # Block # Lot Sq
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1 °' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths '/, 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, materrial& profit) $ ya0o , C7 C7
Description of Work: 114 I [ r) /� I ' c r/rn S; X. t
Vg04-C>F KI-DO 2C£SS I i L,l1
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: /�
Electrical civ? C( V- Mechanical
Framer Roofing
Solar Other
Concrete
Other
aCcr.�-, (�J£ r � r�✓
Plumbing
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 Fort C Ilins rdinanc nd state laws regulating building construction. /�
Applicant Signature Print Name L Phone /-1 -p 4?0
Distribution: White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE