HomeMy WebLinkAbout1703 Keel Cv - Applications/Basement Finish - 09/19/2018City of
I 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-, 3�3�
APPLICATION NUMBER �/ vv v IAPPLICATION DATE q I I q Q�C
Job Site Address I`76 3 Ike:- I C ve c r.
Unit #
PROPERTY OWNER
INFO: (All owner information is required — it is not optional) Phone # 17 I
Last name 1 J �( iJ I I First Name Re/V 0 / Middle
Street Address] 70 71 V6e kC-) U&- L /—' City Ff Statedy Zip Y
j� �J
CONTRACTOR INFO: Company Name k�-1 6 /vs , /✓4i �ui AC Contractor Phone # I % O - j l 0 6 119
Lic Holder Name ' ku `6 fVS �. Citv of Fort Collins License # C.165 Supervisor Carl #
Mailing Address l 3�i I�Es� yak 5r City E t� 6 I 1 : ,ems State CD Zip d5-:a
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft
1 s' Floor Sq Ft
Comm'I Sq
2nd Floor Sq Ft
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished 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
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only)
Value of Construction (including labor, material & profit) /$ 0 ✓ 04'�
� Description of Work:
n/1
Temp. Pedestal Yes or No
❑ 150 Amp or Less ❑ 200 Amp ❑ Other
C/d'
Contact Name & Phone # of JOBSITE SUPERVISOR: /
Subcontractor Info: _
Electrical ��Glr%�=Mechanical /' lePlumbing C010-reiy N/r►O�A40,
Framer
Solar
Roofing
Other
Concrete
Other
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 and state laws regulating building construction. t �+
Applicant Signature Z��, , J9i���J° Print Name r f ;A IE �� 5k, Phone 1 70 .31 oew3
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE