HomeMy WebLinkAbout1200 Nez Perce Way - Applications/Basement Finish - 04/13/2015City of
I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collins
1s 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
/ � www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER APPLICATION
Job Site Address A-9K,0 /V&,7 1'C, _e 664t1, /-G b Unit # �f Q/
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone ` 97V) ac3 ( — ZIP
name 14%Z First Name Middle r
Street Address /a iT.�7_ >�11� GU/i City 16Y/��S State Zip
CONTRACTOR INFO: Company Name Contractor Phone #
Lic Holder Name
Mailing
LEGAL INFO:
City of Fort Collins License # Supervisor Cert #
City State Zip
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1S1 Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths 3/4 Baths '/z 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 #s
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) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $
Description of
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 F rt Collins ordinances and state laws regulating building construction.
Applicant Signature Print Name �/5��/�il% Phone t��t7� a& �17
Distribution: White - Office Yellow- Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE