HomeMy WebLinkAbout1912 W Stuart St - Applications/Basement Finish - 09/26/2017City of I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
/ www.fegov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER r./ I ! \J (J X�O J� APPLICATION DATE / GT �'
Job Site Address /I / 2 5 ty o✓t y r Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name Gly) J
First Name
G (/��,. L
Middle
Street Address y / Z
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City rGl* Cc, l ///I
�_ State CG Zip !
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CONTRACTOR INFO: CompanyName
I j'74j Contractor
Phone # ct�/ -01 6 q�
Lic Holder Name 6 tl 1
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City of Fort Collins License #
Supervisor Cert #
Mailing Address
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City CO 1 P'�v
State Zip 7-
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_
V1 Floor Sq Ft
2^d Floor Sq Ft
# of Stories Bldg Height # Dwelling Units
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft fy # of Bedrooms # of Full Baths '/, Baths Y: Baths # of Fireplaces
t
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: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ / e—aOG
Description of Work: l2-e )<: h i-1f !� ,6a i e t.. 4 en iL, ✓oays. 't-z- ih C lvd B �0+v h d ✓> //err,
✓"C'i-P yo�le, o,' .4 _ a., d /S'P ✓P. 1.,. t1, A,�x
Contact Name & Phone # of JOBSITE SUPERVISOR: Prnel1 13,1 /?/D' 4 7G - % 0/ - (1,17 S
Subcontractor Info:
Electrical Mechanical
Framer
Solar
Roofing
Other
Concrete
Other
Plumbing FVuh� / /Lh7biD,)�
Fireplace
Other
Applicant: I hereby acknowledge that 1 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 Signatures Print Name / �1/1 %3,'% %3i�d Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE