HomeMy WebLinkAbout4608 Regency Dr - Applications/Addition or Alteration - 02/03/2015Cityof
I I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For ` Co"inS 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBERT/TJ o Wo.) (a APPLICATION DATE I � C1
Job Site Address 41(00sr so �3L(6 Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name LJo.yn P SSt'f1'-080'n, /� First Name Middle
Street Address 'ifo Ds- � "x Or. City a State 1 � Zip jL0 '� �
lJ O 'A
CONTRACTOR INFO: Company Name (�ytat Contractor Phone # 7D -3�11 �3J 1
Lic Holder Name �rr =}! �rr� M�,j M a, Y✓ City of Fort Collins License # Supervisor Cert #
Mailing Address 1(o r� ww�if.-1'_Q - City t=1 _ (,e&y5 State Lc-) Zips
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) R(0 J2 D Total Garage Sq Ft
Residential Sq Ft Comm'I Sq
181 Floor Sq Ft
Finished Bsmt Sq Ft
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
2ntl Floor Sq Ft
# of Stories
31 Floor Sq Ft
Bldg Height # Dwelling Units
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths 3/< Baths /z Baths # of Fireplaces
Energy info: ( Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
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) A.
150 Amp or Less ❑ 200 Amp ❑ Other
*3, � �9 nw AI /J _
Value of Construction (including labor, material & profit)
Description of
�r s
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
i
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 Collins ordiaarices and state laws regulating building construction.
Applicant Signature 1 _ Print Name Phone 170-3cl I -35 1'3
Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE