HomeMy WebLinkAbout1207 Matuka Ct - Applications/Addition or Alteration - 03/30/2015City of I I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
/ www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER E/ / v CJ L5 / APPLICATION
Job Site Address I i, -h) CA Ucw)-F ( ) I Unit
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name L IA cizs L4 p I I First Name Middle /
Street Address q � �/i Ato-n lAA nIL j City ( /. �d Stater Zip
CONTRACTOR INFO: Company Name tnm ( V� G, 9s `Yy ddits/r� o e # '56`2 6-36=K
Lic Holder Name 2.1 G City of F Collins License # Lv I Supervisor Cert # % j—f
Mailing Address 1 7/J-, Whe 6 ?� City State zip yps M
LEGAL INF�-
Subdiv' on/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) `7?j Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
15' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3r1 Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths '/< Baths /3 Baths # of Fireplaces
Air Conditioning: Yespor-114 Energy info: ( Cir le ropriate 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 # List appropriate option #s
UTILITIES INFO:
Water Tap Size_ Sewer Tap Size 0 /�> 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, material & profit) $
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
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 of Fort olli s o tces and state laws regulating building construction. Applicant Signature,} L Print NameJ�A �)A I IL4<�- Phone -7 636 3
Distribution: White - Office Yellow -Applicant Pink - WWW/Slormwater