HomeMy WebLinkAbout3214 Anika Dr - Applications/Basement Finish - 05/06/2016'4-'C, OF COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
6etCollins281 N. College Ave. a Fort Collins, CO 80522-0580 a Phone: 970-221-6760fFwww.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER �D V �� APPLICATION DATE ✓
Job Site Address 3 Z- I L, G.,; �, t�f' ,, Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # C -10 -1 L Li r d C
Last name �eycnS First Name Middle 10"IJj ems'/(
Street Address J--70 �'u ° �""�" �� City 1—�l� Inf. StateG0 ZipL11 SZ�
CONTRACTOR INFO: Company Name 0-1 ce' f ' I'J Contractor Phone #
Lic Holder Name City of Fort Collins License #
Mailing Ad
LEGAL INFO:
Subdivision/PUD
City
Filing # Lot #
Supervisor Cert #,
State Zip
Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq
ls' Floor Sq Ft
Finished Bsmt Sq Ft G Ll 0
2r'd Floor Sq Ft
# of Stories Bldg Height
3rd Floor Sq Ft
# Dwelling Units
Unfiished Bsmt Sq Ft Z3
# of Bedrooms I # 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 # List appropriate option #s
UTILITIES'INFO:
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) $ jD D
Description of Work: 7 �I'S c1f 2.1 aI t I'll kn In. ec"( d
/^ "l—
i i n� ti 11 A V"0 ' P 01 tFir n at (t 9 ti ,P_i &h,+ clfl`C
Contact Name &Phone # of JOBSITE SUPERVISOR: 7,3
Subcontractor Info:
Electrical Se-i F- Mechanical
Framer
Solar
Roofing
Other
Concrete
Other
Plumbing �.fe
Fireplace
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. f L
Applicant Signature — Print Name �61-1 e Sy 'r�y� �_j Phone 9-70 -7 Y L/ 8'0 13
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES.180 DAYS FROM APPLICATION DATE