HomeMy WebLinkAbout936 Deerhurst Cir - Applications/Basement Finish - 08/10/2017 (2)City
}of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
FOI ` Collins, , 281 N. College Ave. • Fort Collins, CO 80524 a Phone: 970-416-2740
/ � www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 5- 1U `�E APPLICATION DATE if I t
Job Site Address93/ _� (�JIJA Unit #,
PROPERTY OWNER INFO, (All owner information is required - it is not optional) Phone #52--) 5-a( a3(>_
Last name First Name Z Middle
Street Address City � �f -V State�_Zlp442�a'
CONTRACTOR INFO Company Nam N Contractor Phone # !ice
Lic Holder Name City of Fort Collins License # C-0Supervisor Cert # 3&773 _C60
Mailing
LEGAL INFO:
City 'a ,g T State C_ Zip
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) /7o3 Total Garage Sq Ft
Residential Sq Ft
10 Floor Sq Ft
Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
- 20d Floor Sq Ft 3itl Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms 5 # of Full Baths % Baths I_ '% Baths # of Fireplaces
Air Conditioning YeGon 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 #
List appropriate option
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered Yes []Noll Temp Pedestal Yes❑ No ❑
Type of Heat ❑ Gas Electric Electric Main Breaker Size (Residential only) Ill50 Amp or Less ❑ 200 Amp Other
Value of Construction (including labor, material & profit)
of Work
.4r-
If
Contact Name & Phone # of JOBSITE SUPERVISO /_J
Subcontractor Info:
Electrical L2tQiL/X Mechanical ko Plumbing Abp'o
Framef7/2ti Vt&4.k10 Roofing Concrete Fireplace tff=
Solar le— Other Other Other
Applicant I hereby acknowledg ie d this application and state that the above information is correct and agree to comply with all requirements
contained herein and City o� s mances and state laws regulating building construction
Applicant Signatur Print Name-�� GT % Phone !!2J9' Z l �
Distribution White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE -