HomeMy WebLinkAbout5620 Fossil Creek Pkwy - Applications/Addition or Alteration - 05/31/2017City of
�t Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
www.fcgov.com/building _#H U 1
BUILDING PERMIT APPLICATION
APPLICATION NUMBER F) 1 I O Q-q v v APPLICATION DATE slat '
Job Site Address Fo'% „I nre,'6 Qv W \/ Unit # /D l n 7'
PROPERTY OWNER INFO: I (All owner Information is required - it is not optional) Phone # /�o - 6 C� GI
Last name t� S� I C�. �, 7 First Name / Middle
Street Address �o %C� ���� + I qt�i . nE�/ �� City 4-� �� �G. State � Zipcy
CONTRACTOR INFO: Company Name 41) 1- `Q��fo Tio Contractor Phone # Q71D -Z 1 �- l IC7n
Lic Holder Name U /� tt City of Fort Collins License #C1= 3 Supervisor Cert #
Mailing Address eol�t rr e �.4 , Lfc_ K_ City Q ILNa1%o,r State C-b Zip 0,5!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 Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
181 Floor Sq Ft
2nd Floor Sq Ft
3r° Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths '/2 Baths # of Fireplaces
Air Conditioning: Yel]Nou Energy info: ( Circle appropriate choice ) 1. ComCheck11 2. ResCheck w/Air Sealing 11
3. ResCheck w/Blower Door ❑4. Simulated Performance Alternative❑ 5. Prescriptive w/Air Sealing11 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
List appropriate option #s
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) F]150 Amp or Less 11 200 Amp 0Other
Value of Construction (including labor, material & profit) $ i 1) 7 z- 3. 0
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR: C / 7O -'37 3 - & n`"(
Subcontractor Info:
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t
Electrical` etl�; �(ej-+'I �' Mechanical ID fl (, A:C Plumbing
Framer c7(jibe_C.k Roofing Concrete Fireplace
Solar
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 - -� Print Name I ? • J GS S ke-i G( Phone /, �/
b - 37S - �i!9
Distribution: White -Office Yellow -Applicant Pink - WWW/Stonnwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE