HomeMy WebLinkAbout2632 Autumn Harvest Way - Applications/Single Family New - 09/21/2005Fort Collins
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER V 19 \�� APPLICATION DATE- 47`
Job Site Address o? & ,3a �¢y�-y",y -/A,e sr `v r Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 20 •? - 9 — 9'.-
Last Name %fiV/, ,Q<, B4 ,7?- C_First Name Middle
Street Address `7� ( _� � �vSn- CT f b3 City b civy&.Q State Ch Zip 06a
CONTRACTOR INFO: Company Names-��! /� /� p�qi•� • r- Contractor Phone #_202
Lic. Holder Name�f.Q�2�</ G� �Ele -r,525ree City of Fort Collins License # Q1 - Supervisor Cert
Mailing Address -5'4i e- -4S City State Zip
LEGAL INFO:
Subdivision/PUD_ Filing # ( Lot # fd Block # %oi Lot Sq Ft
CONSTRUCTION INFO' Total Building Sq Ft (not including basement) % Total Garage Sq Ft 7 02
Residential Sq Ft 2?1 Comm'I Sq Ft # of Stories---? Bldg Height -23 1 # Dwelling Units i
1st Floor Sq Ft -7D p 2nd Floor Sq Ft 7 Unfinished Bsmt S Ft ���
q Finished Bsmt Sq Ft
# of Bedrooms # of Full Baths C�'? % Baths '/ Baths # of Fireplaces
Air Conditioning: Yes (D Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # �33 I List appropriate option #s i o?
UTILITIES INFO:
Water Tap Size �i�_ Sewer Tap Size Metere<�S) or No Temp. Pedestal • Yes or No
Type of Heat: XGas ❑ Electric Electric Main Breaker Size (Residential only):,N150 Amp or Less 11200 Amp ❑ Other
Value of Construction (including labor, material & profit) $
Description of Work:�licJG ��'� �,, ' / y ES�G?�E�v� c l✓
Contact Name & Phone # of JOBSIT99UPERVISOR: L.Dyiv� C F�C'rfN « ( � cS� 7—�� 3 C/
Subcontractor Info -
Electrical %sr, a Mechanical /!%Z-
Plumbing i4
Framer 14� Q L Roofing C- D ID Concrete J ,4 G S 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.
Applicant Signature ,.- 2 Print Name /{ If Oe8 -6— S Phone 2Q3�-
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE