HomeMy WebLinkAbout2826 Canby Way - Applications/Deck - 05/11/2016CRY ®f COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER ICJ I U O a I I a APPLICATION DATE '5 J 1 1 11 W
Job Site Address 2-S 2-& IjE= P6 6D �' Z� Unit #
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone # /, 7o Zo (gZ //3 97?
Last name 4t-,4i✓ First Name 1 -'tVi Middle
Street Address Z- 6 DSO Cam % y City �' State 60 Zip O5 z'
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address
Contractor Phone #
City of Fort Collins License #,
State
Supervisor Cert #_
LEGAL INFO: g
Subdivision/PUD If -7 /6 . rGt/ Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) 7�2. Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
151 Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3ro Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths 3/ Baths '/2 Baths # of Fireplaces
Air Conditioning: YerNon Energy info:( Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing 11
3. ResCheck w/Blower Door ❑ 4. Simulated Performance Alternative❑ 5. Prescriptive w/Air Sealing11 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
List appropriate option
Water Tap Size Sewer Tap Size Metered: Yes []Nor Temp. Pedestal Yes❑ No El
Type of Heat: D Gas ❑ Electric Electric Main Breaker Size (Residential only) 1:1150 Amp or Less 200 Amp Other
Value of Construction (including labor, material & profit) $ .-�
Description of Work:_ /�
P De_e,
v 6 a!5'4 i fv i A /i O S
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
Phone
Distribution: White -Office Yellow -Applicant Pink -WWW/Stormwater
THIS APPLICATION EXPIRES IR111 13AYS FROM APPLICATION DATE