HomeMy WebLinkAbout128 N Roosevelt Ave - Applications/Basement Finish - 06/23/2017COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
APPLICATION
Job Site Address
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION
Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name &I--(LK First Name�Middle
Street Address g %y GS Fi��c %^ City f't . G L t-t-,A�S State 0!'— C Z/ ipr�-Q/!/
CONTRACTOR INFO: Company Name �� ��% CS (af.-S'�entractor Phone # 4 -353 4O' Y �/
Lic Holder Name City of Fort Collins License # Supervisor Cert #
MailingAddresso c7,C �� city �cState Co Zip Koss d
T
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'I Sq
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
1 s' Floor Sq Ft 2nd Floor Sq Ft 31d Floor Sq Ft
Finished Bsmt Sq Ft # of Bedrooms - # of Full Baths 3/< Baths
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Unfiished Bsmt Sq Ft /
'/2 Baths D— # of Fireplaces
Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
List appropriate option
Water Tap Size
Sewer Tap Size Metered: Yes or
No Temp. Pedestal Yes or
No
Type of Heat: ❑ Gas
❑ Electric Electric Main Breaker Size (Residential only)
❑ 150 Amp or Less ❑ 200 Amp
[:]Other
Value of Construction (including labor, material & profit) $ /,;4 00`J
of Work:
Subcontractor Info: n
Electrical � t /%o(—FC Mechanical �/r�-JJG��LPZ-f � Plumbing /�BUV�A� KU
Framer l/1%J Roofing Concrete Zy � Fireplace
Solar
Other
Other
Other
Applicant: I hereby acknowledge that I have read this apple that the above information is correct and agree to comply with all requirements
contained herein and Citv�f�e o ins ordinances ate I s r -Glating building construction.
Applicant Signature" Print Name Phone b 7
Distribution: ffice Yellow - Applicant Pink - WWW/Stormwater
HIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE