HomeMy WebLinkAbout5537 Golden Willow Dr - Applications/Other - 07/21/2016,,F�ort� Coll�'�
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
www.fcgov.com/building
BUILDING PERMIT APPLICATION
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APPLICATION NUM ER -� �, t k = '� �' � APPLICATION DATE L 1 U L . 7-1 - T01 U
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Job Site Address 55 37 GOLD6_1 G�)l LLO &) Z�& Unit #.
PROPERTY OWNER INFO: (All owner information its required - it is not optional) Phone #
Last name C � 6AL &'�/�i`First Name C�// �/s �—� Middle
Street Address S 5;-.3-7 9CXx AEU /21 LCOL City rMf 60CL(tis State CC) Zip 8ro574C
CONTRACTOR INFO: Company Name C/� %V,,4�� U,�S //� Contractor Phone # .303 `-C�yO rSZ-5- y
Lic Holder Name
City of Fort Collins License # Supervisor Cert #.
Mailing Address City.
State Zip
LEGAL INFO:
Subdivision/PUD (,t%1 UO(GJ / /�(� Filing # Lot #___�L Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq
15' Floor Sq Ft
2"d Floor Sq Ft
# of Stories Bldg Height # Dwelling Units
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths '/ Baths # of Fireplaces
Air Conditioning: YeG Energy info:( Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing ❑
3. ResCheck w/Blower Door 4. Simulated Performance Altemative❑ 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door[
City of Fort Collins Stock Plan #
UTILITIES INFO:
List appropriate option #s
Water Tap Size Sewer Tap Size Metered: Yes ❑NoF—1 Temp. Pedestal Yes❑ No
Type of Heat: ❑ Gas ❑Electric Electric Main Breaker Size (Residential only) 1:1150 Amp or Less ❑ 200 Amp ❑Other
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Value of Construction (including labor, material & profit) $ J �,/...
Description of Work:
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Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical 1-A+, . L11jyj-/✓ let6C.� Mechanical l3 V)L(1vo'�` D66(f Plumbing 1�66�k
Framer
Solar
Roofing
Other
Concrete
Other
Fireplace
Other
Applicant: I hereby acknowle that I have read this application nd state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort llins ordinances and s to la s regulating building construction. c�
Applicant Signature Print Name D,tC//.0 t'— �"��— Phone 303���
Distribution: White - Office Yellow - Applicant Pink - VWWV(Stormwater