HomeMy WebLinkAbout1300 Clementine Ct - Applications/Addition or Alteration - 11/20/2017City of
II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
/ www.fegov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER APPLICATION DATE I I `✓Illy
Job Site Address 130.o GIf—P; -,T.-� C-`T Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 1 ._.2ZG - Z6-1 -1 ii`�-
�j01 W Last name �t�� First Name 5�� y,�'r- Middle
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Street Address �'�740 C' Ies-i t"IrX^^ t ^-+y- Lt EI Cit_y �F�^"r (� C7 State Zip a�SZ�
CONTRACTOR INFO: Company Name JiJ 1 �-►ems ��1 �/ Contractor^Phone #'110-22-]-gyp i 2 , n
Lic Holder Name j4Y Dili- �`( al 6:':jz-. /�-}. City of Fort Collins License # D �r Supervisor Cert # 5-1 ■'
Mailing Address � S `yo%g;W� C-{, • City -F � State C. ZipeVc-)sZ
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'I Sq
15' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3r1 Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms -_ # of Full Baths '/< Baths /z 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) $ 16 Ir
ors-
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Description of Work: 1F-�r')�wz-►- ��.clS.l CE3�.DrZ==*--' r4ri
-T'� tiwlCe . [1- V-x 11 i — f3 E
Contact Name & Phone # of JOBSITE SUPERVISOR:�l
Subcontractor
•Info:
' c�-� 1��
Electrical 1-J�.LSf"t�l1 MechanicalV+t7' �L� tr"�c� Plumbinc4 � qjt j
FrameiP Roofing Concrete Fireplace
Solar Other Other Other
Applicant: I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all requirements
contained herein and Cit F Collins ordin nces and state laws regulating building co structio�nn.. h I �7 ' 7 / L�
Applicant Signature / Print NamD K Y� a t Phone �2 1- b 1 22
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE