HomeMy WebLinkAbout919 Deerhurst Cir - Applications/Patio Cover Or Sun Shade - 06/06/2016COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
of
F6rt`�Collins
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 5 I Io0'300 I APPLICATION DATE (0— 6— 16
Job Site Address 11!� ca r-c,Ve� Unit # �
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 1 76 - -5-66 SR1 7
Last name / r e First Name �.7 Middle Sr-?hfib_
Street Address 9 ! a 'I) 42-e xin, u--SA- L- c—a p, City T�, - rei 1 I, A 5 State ('Zip. "502.5
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
Contractor Phone #
City of Fort Collins License #.
City State_
Filing # Lot # Block #
Supervisor Cert #.
Zip
Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft 1 OCR Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
111 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 '/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
Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size
Value of Construction (including labor, material & profit) $
only) ❑y) 150 Amp or Less ❑ 200 Amp ❑ Other
,-), C)
Description of Work: o2 0` 7C --23 f)" -TDc' r11,- W /
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 Collis ordinances and state laws regulating building construction.
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Applicant Signature Print Name �eii k 1 �C� Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE