HomeMy WebLinkAbout4675 Venturi Ln - Applications/Addition or Alteration - 06/27/2017City of II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
/ www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBERINS `�V mot_ APPLICATION DATE 62 � Z �� I
Job Site Address IV %SyE.ir XL T oZ4!VE Unit #.
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone #
Last name Aiiis<i y First Name DAu m! Middle 01
Street Address 41(%af- J1f/(%7—AQCZ City )!�Af CGLL,/W Statea Zip
CONTRACTOR INFO: Company Name Contractor Phone #.
Lic Holder Name SELF City of Fort Collins License #
Mailing Address
Supervisor Cert #
State Zip
LEGAL INFO: ?
Subdivision/PUD ESTATE" Filing # 3 Lot #.3�Block # Lot Sq Ft y3s6a
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft76' q g g g
Comm'I S Ft �-' # of Stories / Bldg Height l # Dwelling Units
1 st Floor Sq Ft S 7 g d 2nd Floor Sq Ft 3rd Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft S%O # of Bedrooms # of Full Baths '/4 Baths '/z Baths # of Fireplaces _
Air Conditioning: Yes Q 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
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: RI rGas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ Aft AAv A r
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical L.O rrJ,O,, .t4 1-54-i r.Qe-Mechanical Plumbing ��//�
Framer
Solar
Roofing A%1495 Concrete
Other
Other
Fireplace
Other
Applicant: I hereby acknowledge th I have r ad this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fo ances and state laws regulating building construction.
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Applicant Signature Print Name /t►�� ao Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE