HomeMy WebLinkAbout719 Benthaven Ct - Applications/Reroof - 09/08/2014City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rt Collins
1s 281 N. College Ave. • Fort Collins, CO 80524 • Phone. 970-416-2740
www.fegov.com/buliding
BUILDING PERMIT APPLICATION
APPLICATION NUMBER D1 9)) ! / ` 1 APPLICATION DATE q ! l�
i
Job Site Address ~I I c , Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 1 -70 - 3-7-7 - a eq
Last name L7� �1 C h First NamepLL1 L'�G1�1 a� Middle /+ (,�
Street Address j l � P r-yh,) ea-W.o 11 city) f D ZA- Cif 11 I'll S State C0 Zip YJd JAV
CONTRACTOR [!`Q: Company Name Xk� 11 1 t') IZ40) nContractor Phone # 1)3 (ymr, tatr7
,/ y,� r R
Lic Holder Name ;f:,.C� //�'"1 �� 11')-Q QCoi� (i Gity of Fort Collins License # . " 7.�Supervisor Cert #'�_
Mailing Address 1i'T�,A ��r A� al I� —e f,S`il Y{'
V� City IVI\,Vt'e State Co Zip o-i 7
LEGAL INFO: df/ Cj
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft `
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) 3o`i .+9-. Total Garage Sq Ft
Residential Sq Ft Comm9 Sq Ft # of Stories Bldg Height # Dwelling Units
151 Floor Sq Ft
2nd Floor Sq Ft
31° Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths 'Y2 Baths # of Fireplaces
Air Conditioning: YeGon Energy info: ( Circle appropriate choice) 1.ComCheck11 2. ResCheck w/Air Sealing
3. ResCheck wBlower Door 11
4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing11 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
List appropriate option
Water Tap Size Sewer Tap Size Metered: Yes Doll Temp. Pedestal Yes❑ No
Type of Heat: Gas ❑Electric Electric Main Breaker Size (Residential only) 11150 Amp or Less ❑ 200 Amp ❑Other
Value of Construction (including labor, material 8 profit) $ � 9,�_cyc)
Description of Work:,
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Mechanical ,
Roofing _TQP i Qua"+ Concrete
Other
Other
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
1of/F7ort Collins ordinances d slate laws regulating building construction.
Applicant Signature�� I' 1 7t1 tau/°/Vt Print Name f )je jCtlj 1 e I? Yi)Phone 3D3"- ( 00- 7&&3
Distribution: White -Office Yellow -Applicant Pink -WWW/Stormwater
THIS APPLECAT110M EXPERES 160 DAYS FROM APPL.ECA 110M CATS