HomeMy WebLinkAbout1200 Matuka Ct - Applications/Addition or Alteration - 09/05/2014COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
APPLICATION
Job Site Address
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION
Unit # �� 'Sr
PROPERTY OWNER INFO: (All owner information is required -it is not optional one # +Le Z-6 I
Last name �� }1GT Li D First Name Middle
Street Address �� o � 4, I�City 6 l go 2� W t � State lzip �S
CONTRACTOR INFO: CompanyName-611VtK a�?5)��>�actor/Phone # 56 / 7 /-305
Lic Holder Name �)�1 �« City of Fort Collins License # t\Jr(o</<j Supervisor Cert # 5
Mailing Addressj2`1; U) , NOA A 10 �07_ City Q0 C� t State zip��
LEGAL INFO:
Subdivi ' /PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) I 45-b Total Garage Sq Ft
Residential Sq Ft Comm'I Sq
15' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
# of Stories
31d Floor Sq Ft
Bldg Height # Dwelling Units
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/z Baths # of Fireplaces
Air Conditioning: Yes 00
Energy info:( Circle ap"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 # A " List appropriate option
UTILITIES INFO:
Water Tap Size k �A Sewer Tap SizqOA_ Metered: Yes or
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only)
No Temp. Pedestal Yes or No
❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $���1z-
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
)4C11
Plumbing
Fireplace
Other
Applicant: 1 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 of din rice a state laws regulating building constru tion.
Applicant Signature \ �i% ., — Print Name Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE