HomeMy WebLinkAbout3450 Lost Lake Pl - Applications/Basement Finish - 03/07/2016Fort Collins
APPLICATION
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
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BUILDING PERMIT APPLICATION
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Job Site Address E �".>� ..'�e
APPLICATION
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Unit # _J .�
PROPERTY OWNER INFO: All owner Information is
( required — it is not optional) Phone # �0
Last name I; ooia- First Name '12 '_.,: b Middle
Street Address f _",`, �- I%
city a I Y `,t State �¢''fi ,, Zi p'i
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CONTRACTOR INFO: Company Name Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address City.
LEGAL INFO: cop
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State Zip
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</ Subdivision/PUD (;i !7!1' Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft �51 d
Residential Sq Ft ;�'t Comml Sq Ft # of Stories c' -, Bldg Height # Dwelling Units
t5' Floor Sq Ft ! ®I 2"d Floor Sq Ft �` `i 3- Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms 3 # of Full Baths % Baths '/z Baths # of Fireplaces 1.
Air Conditioning: YeiVoo Energy info:( Circle appropriate choice) I. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door F14. Simulated Performance Alternative® 5. Prescriptive w/Air Sealing[] 6. Prescriptive w/ Blower Doofl
City of Fort Collins Stock Plan #
UTILITIES INFO:
List appropriate option
Water Tap Size Sewer Tap Size Metered: Yes If
Type of Heat: EfGas ®Electric Electric Main Breaker Size (Residential only)
Value of Construction (including labor, material &
Description of
Contact Name 8 Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
� f .A
Electrical 8 �; d i 1 G '&' �-I L°GYn t'
Framer 11011 IF) (1 L 1 f/Jt f ff'()Roofing_
Solar Other
Temp. Pedestal Yes® No®
50 Amp or Less g® 200 Amp ®Other
Mechanical r J 'f4e0 i fig' 0 Plumbing
0
Concrete Fireplace
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 o ort Ilinji; ordinances and state laws regulating building construction. j,�
Applicant Si nature ��.�:� t �-•� ,>" Print Name �- Phone 7
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Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
% H"M AP PLOCA` OON EXPNRe.8 180 DAYS FROliiil APf:=''I? ICA 101M SATE