HomeMy WebLinkAbout3664 Galileo Dr - Applications/Basement Finish - 01/19/2016F&t_Cotlins ____281 N. College Ave. - Fort Collins, CO 80524 - Phone: 970-416-2740
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BUILDING PERMIT APPLICATION
APPLICATION NUMBER 61LOO O D J APPLICATION DATE ' 119 11
Job Site Address 366 y (, . (e° (� ,_
Unit #
PROPERTY OWNER INFO: (All owner information is required —it is not optional) Phone # 97 10 J 6 O 1 — 3-764-1
Last name a LA CA- First Name J a S 0VxI Middle
Street Address 3E6� °k CO �'� City r— d
CONTRACTOR INFO: Company Name
Lic Holder Name
a(
Contractor Phone #
City of Fort Collins License #
Mailing Address City
State e- 0 Zip
Supervisor Cert #
State Zip
LEGAL INFO: '',, II I V
Subdivision/PUDw' 1�00'("0 ��servalor 4*'I. t Filing # 3 Lot # S� Block # Lot Sq Ft_,
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of St g Height # Dwelling Units
15' Floor Sq F _ 2nd Floor Sq F . �_ 3'd Floor Sq Ft
Finished Bsmt Sq Fi ?)OD 3edroor 0 =ull Ba 1 '/ Baths # of Fireplaces
Air Conditioning: Yei AV Energy info:( Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing ❑
3. ResCheck w/Blower DoorE 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
Unfiished Bsmt Sq I
Water Tap Size Sewer Tap Size Metered: Yes171NoF7 Temp. Pedestal Yes No
Type of Heat: Ix I Gas Electric Electric Main Breaker Size (Residential only) ❑150 Amp or Less ❑ 200 Amp ❑Other
Value of Construction (includinc
Description of Work: r �S
labor, material & profit)
Contact Name & Phonef# ff JOBSITE SUPERVISOR:
y
Subcontractor Info: eV [r 1
Electrical
Framer
Roofing
Mechanical
L ( imy l l ,
Concrete
Plumbing
Fireplace
Solar Other Other Other
Applicant: I hereby acknowl at I have read this a lication and state that the above information is Corr t and agree to comply with all requirements
contained herein and Ci f Fort Collins ordinances a state laws regulating building con truction.
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Applicant Signatur Print Name asvh Phone
Distribution: White — Office Yellow —Applicant Pink — WWW/Stormwater