HomeMy WebLinkAbout1914 Silvergate Rd - Applications/Deck - 10/05/2015City 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 8M �0�(/ APPLICATION DATE l D-%5—l5�
Job Site ,Address Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not
optional) Phone # q 70 ``1 �'�
2-q
Last name i'CGYVI.C2� First Name Vl Middle `Y
Street Address \ q14 S 11\%erV\C& E City f 6c cd ( I -Ir�— State CV zip
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft lico Comm'I Sq Ft
15' Floor Sq Ft
2"' Floor Sq Ft
Contractor Phone #
City of Fort Collins License # Supervisor Cert #.
City
Filing # Lot #.
State
Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3r' Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % 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
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) $ vP�9J
Description of Work: �1 S Ms *NAk ey-'j Sh ulc-\ �LL� ,bU� (A
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 -V Coll i s ordinances and state laws regulating building construction.
Applicant Signature` v Print Name �keGVv✓\� Phone `nO 21cl 7293
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE