HomeMy WebLinkAbout5327 Old Mill Rd - Applications/Basement Finish - 10/11/2018City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort COtIinS 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
/ www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 1 82 � APPLICATION DATE 'O ' l I 'd
Job Site Address 5S21 011J, Mill GU1niit�# y�
PROPERTY OWNER INFO: (All owner information is required -it is not
optional) \�/Phone # ti J T`a
Last name /WVA/< First Name V AC1 dq / Middle
Street Address 04 411tV gO( City fbk+ C..6//1 12S State 60 Zip S{
CONTRACTOR INFO: Company Name
I
ILic Holder Name
Contractor Phone
City of Fort Collins License # Supervisor Cert #.
Mailing Address City
LEGAL INFO:
Subdivision/PUD
1
CONSTRUCTION INFO: Total Building Sq Ft (not including
Filing # Lot #_
State
Block # Lot Sq Ft
Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft xUnfiished Bsmt Sq Ft
'�Finished Bsmt Sq Ft `7`SO of Bedrooms )(of Full Baths '/< Baths the 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 # List appropriate option #s
UTILITIES INFO:
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 L/eesss ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $
7� 1
Description of Work: F/ hl Si(i / CG <eM Prt�
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: ---
Electrical Mechanical
Framer Roofing Concrete
Solar
Other
Other
bing
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
VApplicant
contained herein and City of Fort Collin's ordina ces state laws regulating building cfonssttruction.`` LL'�7� Signature 'rintName VaCkj, �lx Vhone �T40(5_3t�S/ Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
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THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE