HomeMy WebLinkAbout837 Bitterbrush Ln - Applications/Deck - 06/07/2017�v
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City of
Fort Collins
APPLICATION
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
www.fcgov.com/building
BUILDING PERMIT APPLICATION
00 �3 APPLICATION DATE (0 -7 - 17
Job Site Address n-,�) 1 t&,f l Mj'<z�l L LU 11.. Unit #
PROPERTY
--OWNER
,IINF& (All owner information is required- it is not optional) Phone #
Last name (� First Name?-))r-v _ 1 Middle
Street Address�QQy�� l (one, ^ �C City%WI `i State( D �7Zip Q Q�
CONTRACTOR INFO: Company Name �� fvL,Qn/h� �tL WI �J � Contractor Phone # c" `� 1 -g T lS V
Lic Holder Name s X�L�X t t Ll�ri City of Fort Collins License # Ph1Yr(F-7)2- Supervisor Cert #
Mailing Addressp ' ' IL T\ - City State eo Zip
s
LEGAL INFO:
Subdivision/PUD l>A` Filing # Lot #�_ Block #_ Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft r5V_ Comm'I Sq Ft
1s' Floor Sq Ft
2n° Floor Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3`" Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths /2 Baths # of Fireplaces
Air Conditioning: YerNoH 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 Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan # List appropriate option
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes [--]Nor-] Temp. Pedestal Yes❑ No
Type of Heat: ❑ Gas ❑Electric Electric Main Breaker Size (Residential only) 1:1150 Amp or Less 11 200 Amp Other
Value of Construction (including labor, material 8 profit) $ 51400
Description of Work:Otc,yl
Contact Name 8 Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowle ge that I have read this application and state that the above information is correct and agree to comply with all requirements
contained her and City o brt Col'ns ordinances d state laws regulating building construction.
Applicant Signature Print Name � ,f-n! Phone %7P> �lZ 9
Distribution: White - Office Yellow -Applicant Pink - W W W/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE