HomeMy WebLinkAbout309 W Trilby Rd - Applications/Accessory or Secondary Building - 07/08/2016Cty®f COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rtCollins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760� y-
www fcgov corn/building
> � J
�- BUILDING PERMIT APPLICATION
APPLICATION NUMBER 6 I �� �� ✓4� (�F'J> CATION DATE 17, &' &
Job Site Address _3 d q vy *,91 L 3Y Unit #
I
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone #
Last name /7��3lz-t t'1 `/�'� First Name p O�;Vl Middle
Street Address IFL3 �G j ,� r' Cit71&% 0 G'CC Ikt,�5 Stater 0 Zip-,Vf6-525^
CONTRACTOR INFO: Company Name Contractor Phone #
Lic Holder Name
City of Fort Collins License #
Mailing Address City
LEGAL INFO:
Supervisor Cert #.
State Zip
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
111 Floor Sq Ft 2nd Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths 3/ Baths '/ 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 #s
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: T Gas [ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
G
Value of Construction (including labor, material & profit) $� o/
Description of Work:
�,Cx L'� iC� � �� (n1.-�_ ���w C7( Lch.C� _ / (,.,j�►S(..vi � �t �d�. � - i'1Qir
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical De( )AJ t1-1Or+n d/l(,j Mechanical
Framer
Solar
Plumbing
Roofing Concrete ax Fireplace
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 Rd t Collins ordinances and state laws regulating building construction.
Applicant Signature —Print Name Phone
Distribution: White —Office Yellow —Applicant Pink — WWW/Stormwater N
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE 1(YA10 (�'�