HomeMy WebLinkAbout4331 Mill Creek Ct - Applications/Addition or Alteration - 04/15/2016City ®f COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rt Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER b I (10 19 �ed q APPLICATION DATE
Job Site Address y :331 111 ; 111 C-eE F. fe G /, 60Sj(o Unit #.
PROPERTY
rOWNER INFO_ (All owner information Is required - it is not optional) Phone #
Last name W t (' A-vvi S + First Name Q ttL/ .'` i4-t'-C, Middle
Street Address y3I (D i C2 F I� City �-C7.2. I (mac' � I e Iry S� State e(" Zip os)-&
T
CONTRACTOR INFO: Company Name� �I'py�i V � GUAr� I Q-Gte idAGontractor Phone # !�
Lic Holder Name / / ,I4 JZ e- /l..- i-oto t At /� _ City of Fort Collins License #� Supervisor Cert #
Mailing Address 7 y �-N✓J ✓ ✓ k� ! �� City lyll2 I Cal I t �-S State �� � Zip
LEGAL INFO:
Subdivision/PUD Filing # Lot # 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 Stories Bldg Height # Dwelling Units
15' Floor Sq Ft
2nd Floor Sq Ft
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths '/z 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) $ � 5 �(9, 0 0
Description of Work: PL�—AA 0 UW.tn/yVu✓ ill-4 ,LwS ✓� �I
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical 61I�i2C Mechanical
/J �
Framere q-) u van. % ��' �I+ Roofing
Solar
Other
Concrete
Other
i2
Plumbing
IA —
Fireplace
C�I=
P, l
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 C (Iins rdin�es state laws regulating building construction.Applicant Signature rL Print Name I �ilL �Z �• �I i? i ti l Phone 01 L%
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater