HomeMy WebLinkAbout3449 Fieldstone Dr - Applications/Addition or Alteration - 11/30/2015F6rt
Cityof IICOMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fegov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER � I S ®OA 1 _ APPLICATION DATE 11 JC)
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Job Site Address --3�9 V1- t LUnit #
PROPERTY OWNER INFO: (All owner information is required— it is not optional) Phone # 1�C� Z��
Last name � L o�" ((�� First Name Middle
Street Address SLi L` � f l� J&S (O &e- ppCity k C� ^ S _ _ StateC c7 zip &�.T Z
CONTRACTOR INFO: Company Name CO �O�^S���c ..a.. l�Jcg- Contractor Phone # C0�0 LAq 03��
Lic Holder Name (ne- 161; Q-- City of Fort Collins License # e ` �LI Supervisor Cert # '�ZA `C-
Mailing Address ��3 cz-1f eA& UvbJy` Dr- City J0 State CD zip zc�3-3
LEGAL INFO:
Subdivision/PUD
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO_ Total Building Sq Ft (not including basement) ?- �- C) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories.
151 Floor Sq Ft
Finished Bsmt Sq Ft
2°d Floor Sq Ft
3rd Floor Sq Ft
Bldg Height # Dwelling Units
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/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 #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) $ 0 0r 00c)
Description of Work: 1 A'k(1kal\ 6e SJu\ toojy\� �) �\du"y,o
Contact Name & Phone # of JOBSITE SUPERVISOR: C`110- af-A Q. ftk--t .,,�- - C`
Subcontractor Info:
ElectricalRtx"an UY�eFi��lC� Mechanical r Plumbing
Frame� � ��A�Roofing ��. Z � Concrete I-- L'tccwd�: "`"Fireplace
�l
Solar
Other
Other
Other
Applicant: I hereby nowledge tha aver his application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort Collins o inances nd state laws regulating building construction.
Applicant Signatur Print Name (--leo' L u Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE