HomeMy WebLinkAbout407 S Grant Ave - Applications/Addition or Alteration - 09/07/2017COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER a 1-1 D 5 a.o 0 APPLICATION DATE q
Job Site Address %D % ee) n F/ g&t// S r Unit #
PROPERTY OWNER INFO: (All owner information is required - itisnot optional) Phone # / /t a -
Last name ��)�F�C��Iz/ /� ' (First Name C f/��� A/� 1 A .) Middle
Street Address y� �f) t) 1 � 0�/�/"� I City f C pLL/�f/.� State�QZip /� p
CONTRACTOR INFO:
Company Name k /r 1, / (Q�I �O� 61 j /O�ontractor Phones #
Lic Holder Name JA1''1,E.� 4-/�,L / ^City of Fort Collins License #) 4. 4W5 Supervisor Cartes##
Mailing Address 'j-d de % / /`i ��il//c'� /PJl City /� TCOLLIN S StateOeZip
LEGAL INFO:
Subdivision/PUD /� �C% / ���C� Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm] Sq
1s' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3rd Floor Sq Ft
# of Bedrooms # of Full Baths 3/4 Baths
Unfiished Bsmt Sq Ft _
Yz Baths # of Fireplaces
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
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) $ .mil V ao
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR: Jf(-i" C S // 'G. 9�0✓��� (�cT
Subcontractor Info:
Electrical Mechanical
Framer Roofing
Solar Other
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby ackno pledge that I have read this araws
and state that the above information is correct and agree to comply with all requirements
contained herein and City f Fort Collins o i a s regulating building construction.
►
Applicant Sign Print Name��/i�/Cr] L L I�XfL Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE