HomeMy WebLinkAbout812 Grandlake Ct - Applications/Addition or Alteration - 12/18/2015City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rt Collins p� IS 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER �/ 15w_7 9 0 APPLICATION DATE I
Job Site Address qi a 6r-'m& Lea_'e. al Unit #.
PROPERTY OW�NE1R INFO_ (All owner information is required -it is not optional) Phone #
(
Last name 1 oOD i ^ First Name C7 i I MOUJ_ Middle
Street Address �I (;nL1Y� J�x}L� C i City �O� 1 C�I�i i15 /S�tate�O Zip i�0J�
CONTRACTOR INFO: Company Name WIOCCLc,6 &AAaj+'o/I Contractor Phone # l 70-29b--7 i 15
Lic Holder Name .C' e�c !6t.4 'Ph �Q i ,�S City of Fort Collins License # Supervisor Cert #
n/I
Mailing Address ��i�oL ��a�fl'1fy) � City )LO✓c?1Ank State (' O Zip SOS 3%
LEGAL INFO:
Subd
CONSTRUCTION INFO:_ Total Building Sq Ft (not including
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
151 Floor Sq Ft
Finished Bsmt Sq Ft
2ra Floor Sq Ft
T6 Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '% 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) $ _ r �cc, o0
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR: .1e4�re_Lk `7 /U .-J-lu
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 eand stale laws regulating building construction.
Applicant Signature_. Print Name ., _Wirebk ��1. I�; n� Phone Cg�) 990`711C;
Distribution: White - Office Yellow- Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE