HomeMy WebLinkAbout4902 Corsica Dr - Applications/Single Family New - 12/01/2015QW 07, COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
4 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
Fort Collins
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER�b 15D 3 C-[5, 1 APPLICATION DATE
Job Site Address q 40Z 4?,z ° Unit #
PROPERTY OWNER INFO: (All owner information is required— it is not optional) Phone # �j'V
Last name �fl7�ti✓ASS 11etiGlc`2fkZ"L�' /First Name ►)/� OTC Z` Middle
Street Address ��� d /"lCtG4 city, t ��"�S State (.y Zip (.S Z
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CONTRACTOR INFO: Company Name �7�t✓P,h��� �� RPO e y1Si i h Contractor Phone
Lic Holder Name l � 'S �d/kLl �r� e"e City of Fort Collins License # Supervisor Celt ##
„ Mailing Address %� a a G� City r�' ��ws State Zip
LEGAL INFO:
Subdivision/PUD bl 1+t hV " (isT lOn WC%) Filing # Lot # Block # Lot Sq Ft 104
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) /832 Total Garage Sq Ft 1 61> A/6 3
Residential Sq Ft 1 Comm'I Sq Ft # of Stories Z- Bldg Height C // #Dwelling Units
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15' Floor Sq Ft % 1172°d Floor Sq Ft I( 31d Floor Sq Ft
Finished Bsmt Sq Ft # of Bedrooms 3 # of Full Baths __.L % Baths
Unfiished Bsmt Sq Ft I ?_ Y?
Baths / # of Fireplaces
Law
Air Conditioning: Ye Ro� Energy info: ( Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Seali
OWN
3 esCheck /Blower Door . Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan # List appropriate option #s
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes 4NoD Temp. Pedestal Yes , No ❑
Type of Heat: Gas Electric Electric Main Breaker Size (Residential only) �150 Amp or Less.42Amp Other
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Value of Co struction (including labor, material & profit) s_ t�y�c
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Description of Work: 1yI ly��'L' lGK'T
Contact Name & Phone # of JOBSITE SUPERVISOR: �. qos `V9 ?U Y9S-0
Subcontractor Info:
Electrical �d�IlF�1nAA �e i'' G Mechanical rol-k 0 1* A IA;t Plumbing✓��
Framer f&( / t d Roofing Concrete Fireplace
Solar Other Other 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 Fort Collins ordinances /and state laws regulating building construction. // -�J
Applicant Signature_ I tit%1 S r �1f-/�� i7fI � Print Name / /S f.i`-t f �� Phone `�`%� G -Q
Distribution: White — Office Yellow— Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE