HomeMy WebLinkAbout4703 Prairie Vista Dr - Applications/Gas - Log, Line, Pipe - 04/06/2015City of 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 (�i5a 0 a --I`I'
l APPLICATION DATE 4-L. - 15
Job Site Address / r2k,/re� Unit # /
PROPERTY OWNER INFO: (All owner information is required— it is not optional) Phone # 3J03- �! ( - ,dW9
Last name Firstj,,�a�me Middle
Street Address T�/.,1 V'l� 1/t`i CtJT'o City ce5/AIK State Zip �Jd_
CONTRACTOR INFO- Company Name Contractor
�Phone # �� �1 / i ` 1�66
Lic Holder Name d City of Fort Collins icense 4L Supervisor Cent
y Zip D5 ���
Mailing Address o Cit State
LEGAL INFO:
Subdivision/PUD 4Filing # Lot # -L Block # Lot Sq Ft
CONSTRUCTION INFO: Tot Building S Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1 s' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
31d Floor Sq Ft
# of Bedrooms # of Full Baths % Baths
Unfiished Bsmt Sq Ft _
/2 Baths # of Fireplaces
Air Conditioning: Yes No Energy info: ( Circle appropriate 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 #
UTILITIES INFO:
List appropriate option
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: f 'Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $
of W
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontra info,
Electrical ac4l r-111C.Mechanical
Framer
Solar
Roofing
Other
Concrete
Other
e
Dj "9
Plumbing 6C0 Irlum
Fireplac
Other
Applicant: I hereby acknowledge hat I have read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City o Fortt ooIrpp�/j�ordmances and state laws regulating building cSlill
ction. // L_ / /
Applicant Signature �t:rQ'� 11 Print Name 431V, ✓' /�> t' Phone _6f -ga6`6
Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE