HomeMy WebLinkAbout1420 E Stuart St - Applications/Electrical - 10/14/2014City
}of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6r` Coilins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416.2740
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER f� I 1 O q(YOv APPLICATION DATE
Job Site Address C • OPA P,4W Unit
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name C li ir/Vor—r-o t - (rouil if — P"First Name Middle
StreetAddress�/3 S PIZY&I hyc city
1,�.,U/11y/,—,,.ze�.OL141YE aState Co Zip £�0Sz
i
CONTRACTOR INFO: Company Name �i�3ri rIC4 /Yin' OOvontractor Phone # 3c73 4{SO
Lic Holder Name. k�_I (N aeStflut t City of Fort Collins License # Supervisor Cert #
Mailing Address 16y-7,i 1-ma Driue,4�1-i city W�((!no State Go zip16.?_1-'1
LI*9-11W1rA
Subdivision/PUD Filing# Lot #_ Block# Lot SgFt
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) �7'� Total Garage Sq Ft
Residential Sq Ft
1S1 Floor Sq Ft
Finished Bsmt Sq Ft
Comm9 Sq Ft # of Stories Bldg Height # Dwelling Units
2nd Floor Sq Ft
3n Floor Sq
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths _ % Baths _ % Baths _ # of Fireplaces
Air Conditioning: YeGol? Energy info: ( Circle appropriate choice ) 1. ComCheck ❑ 2. ResCheck w/Air Sealing 11
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 # List appropriate option #s
UTILITIES INFO: -- N/�`
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 Amp or Less ❑ 200 Amp Other
Value of Construction (including labor, material & profit)
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR: R1ck 303 9Q �- 1478 `(
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknow dge that I have read this application and stale that the above information is correct and agree to comply with all requirements
contained herein and City Fort Collins o dinanc s and &tale laws regulating building construction. /
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Applicant Signature Print Name )(i'_k ! Jil�'J/ /i (/l� Phone IQ3 5%1-q joy
Distribution: White - Office Yellow -Applicant Pink -WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE