HomeMy WebLinkAbout2713 Jewelstone Ct - Applications/Improvement Location Certificate - 10/18/2017city}of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
FOI a Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
/ www.1fegov.corn/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER e `- v W-16LA APPLICATION DATE to - I V t l
Job Site Address alk'3 Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # ( R1 b) -v� (O - -1 (0 p
Last name -AinflMO..S First Name f� Y1 S Middle
Street Address 2ll 13 -Ne i i�el4s±h r� e. City FD r t C' c.11 \ tl C statC,,L_zip
CONTRACTOR INFO: Company Name 7Y LTC eA %0l n0 'c`IC �PC ontractor Phone #7 qb • �OkOcl• J �p-CoZ
Lie Holder NameJ6lS n E VJ % nQ City of Fort Collins License #MM _ 1,,r, Supervisor Cart #
Mailing Address%. 1o5 I.oc><h ..d Flv-e. , city nvetA Qo,A State CA Zip %05300
Subdivision/PUD Filing #,
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)- .L
Lot # Block # Lot Sq Ft
Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
is Floor Sq Ft
21 Floor Sq Ft
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths '/2 Baths # of Fireplaces
Air Conditioning. Ye�]Noo Energy iMo: ( Circle appropriate choice ) 1. ComCheck ❑ 2. ResCheck w/Air Sealing 11
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 ❑NoD Temp. Pedestal Yes❑ No ❑
Type of Heat D Gas ❑ Electric Electric Main Breaker Size (Residential only) 1:1150 Amp or Less ❑ 200 Amp ❑Other
Value of Construction (including labor. material & profit) $. 483_ 80
Description of Work:_ _1:r,5 G\I I 7,
C SiIQde 0-n\jPY'.
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor brio:
Electrical
Framer
Solar
Mechanical
Roofing Concrete
,kl,
Other
Plumbing
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 Cg11ins ordinances and state laws regulating building construction.
Applicant Signature Print Name Uuls n F w k Phone blo9 .3161 oL
Distribution: White -Office Yellow -Applicant Pink -WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE