HomeMy WebLinkAbout4759 Brenton Dr - Applications/Basement Finish - 05/16/2016COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 1�: �a/ %�ZS�IA' APPLICATION DATE
Job Site Address '11-5 `t' VS rze-y--�OtJ P12 Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 3o 1- ' -4-4 -Z : 3
Last name M 1t—P"%.c!-- A�- First Name LtiKC-' Middle
Street Address 1y'4-S1 � � �'� T-PK City 4*17✓ -1- e0 -` I i'-'S State CO Zip
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
Contractor Phone #
City of Fort Collins License # Supervisor Cert #,
City
State
Filing # Lot # Block #,
Zip
Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq
1s' Floor Sq Ft
2nd Floor Sq Ft
# of Stories Bldg Height # Dwelling Units
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft 1 1 Z
Finished Bsmt Sq Ft 19'11-1 # of Bedrooms # of Full Baths 3/4 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
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) $ 3 46 % •Z'y
Description of Work: 'FI 1-., \ S t4 Il,�,N yh *--, k S jj-eT> V ks ,=v-1Te1► ' , '� lltiC r��t ,51�-k� A►f GhHF
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
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.
Applicant Signature Print Name LyVtF Phone3o4'q'�+Z 3
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE