HomeMy WebLinkAbout513 Columbia Rd - Applications/Electrical - 12/26/2017City of II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
�t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER t�yAPPLICATION DATE
Job Site Address /'Y /7o��✓r, �. &L Unit #
PROPERTY OWNER INFO (All owner information is required — it is not optional) Phone # SO-5
I
Last name '4 oS e Pig n>h c e First Name /3i�� / Middle ?
Street Address A203 -Tye; c Z'-c 22r City »0%1 State Zip
CONTRACTOR INFO Company Name �m r, .u��io ri [. Contractor Phone # b >/% -A19-3
Lic Holder NamCity of Fort Collins License #/ Supervisor Cert #
Mailing Address / raar-vi Tr City ��G State o. Zip''O$z
LEGAL INFO: / Subdivision/PUD�y,� C o%%U Pi T/ gill�S 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 # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/z Baths # of Fireplaces
Air Conditioning es No Energy info ( Circle appropnate choicl ) 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 JZ Gas ❑ Electric Electric Main Breaker Size (Residential only) JR150 Amp or Less ❑ 200 Amp []Other
Value of Construction (including labor, material & profit) `. 00,
Description of Work z/ q e, , ,
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: r p
Electrical .ZMechanical
Framer
Solar
Roofing
Other
Concrete
Other
Plumbing
Fireplace
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 City of Fort Collins ordinances aQd state laws regulating building construction
Applicant Signatur - / Print Name,-4tei` - !Z L4 o Phone /'Vi�%'��O
Distribution White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE