HomeMy WebLinkAbout607 Mansfield Dr - Applications/Shed - 03/15/2016`' of
F6rtCollins
APPLICATION
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. - Fort Collins, CO 80522-0580 - Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
: C1 APPLICATION DATE *9 -.- I is _' 40
Job Site Address (o o -7 r^ ►d�^�s I= i L L e , F. col 1 Ins Co - Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 9 10 - L9 I - (o953
Xast nameK, -L, %T-ti First Name L� Div tb Middle A4_A h,
Street Address /, 0 i w1 A A s 4Z I a4, City -fG 0'T- State Co ' Zip �-0-!
CONTRACTOR INFO: Company Name Contractor Phone #
Lic Holder Name 20f &441 City of Fort Collins License # Supervisor Cert #
Mailing Address City
LEGAL INFO:
Subdivision/PUD Filing #_
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft Comm'I Sq
15' Floor Sq Ft
Finished Bsmt Sq Ft
21d Floor Sq Ft
State Zip
Lot # Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/2 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:
Water Tap Size Sewer Tap Size
List appropriate option #s
Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 1�570QAmp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ sL 1� / / V
Description of Work:'�R19'�� 'I T -
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical Mechanical —�
Framer O W&Y4
Solar r--�
Roofing
Other
Concrete ------
s
Plumbing
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 of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature Print Name & A >s ►y> KL-%'r N Phone 910 `4,9 1-L�S�
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE