HomeMy WebLinkAbout919 Marble Dr - Applications/Addition or Alteration - 08/02/2016COMMUNITY 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 ([ J I lY t/ WRY 16 APPLICATION DATE
Job Site Address .5?% f JVJ- AG2 B/_ E PjR/U & Unit #
PROPERTY OWNER INFO: (All owner information is required —it is not optional) Phone # r✓/;?d `z6 f 5 576
Last name Ite'l 4G N E-_ Iz First Name OR Q C"E Middle
Street Address i / � I C 12n 10 i= City FT_ e0 z.,zlNS State c40 Zip tj
CONTRACTOR INFO: Company Name %i<G�1 � P-46 t T//& /-//H-/ZT -Contractor Phone # C? 70 -.;;Z[7- -7 ` _'3M
Lic Holder Name . C .11P-r-ny2.►'ta 1-4 f44A-- City of Fort Collins License # Cl-,7 f_3 Supervisor Cert # 72 I"C �
Mailing Address '3 77 at_ fj-Q-4Q9-S_`, L°.7- City W i/ 12-e.0 : State da Zip 9'a 0
LEGAL INFO:
Subdivision/PUD
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft / a / pl ll�J7omm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1 sc Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths X2 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: &1�si
Water Tap Size Sewer Tap Size -K(s ( Metered Yes or No Temp. Pedestal Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) K150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $
Description of Work: TC/-( Db1=1- Aii:_; ! 04-0La_ETS -9 Co0/47-EL2'T6t°5_. tsv t s7-//r4a
�4t:W r ooKTf2T®P /n( P0u-3 p clz scri-4
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical P/>_aL .C'l-ddlC /MC Mechanical CF12T/AI D 0=C1e4FFCCAt,Plumbing CdQ�c�l2/�� P�ol�aR�,e/x
Framer .d0 F5 FAnrd ng N / Concrete /-/ Fireplace
Solar 14 Other 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 %' lall Print Name CAL j FFot2D /-/ _ ��i4o27 Phone We)
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE