HomeMy WebLinkAbout227 Osiander St - Applications/Single Family New - 07/01/2016 (4)City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rtCollins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER IJ I V! V c 1,-3 1 APPLICATION DATE
Job Site Address lVV-k oS� �-gw Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone
Last name First Name 'V-y QN%y. Yl'F' Middle
Street Address sg� CitStateZip C-,-)
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address
LEGAL INFO:
Contractor Phone #
City of Fort Collins License #.
City
Supervisor Cert #.
State Zip
n, v'O 5\n\t)'-A2
Subdivision/PUD `?i\\Q ,-si�G Filing # Lot # ' / Block # � Lot Sq Ft'7,7iVQi
CONSTRUCTION INFO: rrTotal Building Sq Ft (not including basement) �b Total Garage Sq Ft (�/vo
Residential Sq Ft Comm'I Sq Ft # of Stories q, Bldg Height 'LV # Dwelling Units
1s' Floor Sq Ft
Finished Bsmt Sq Ft
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
2nd Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/2 Baths # of Fireplaces
Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
List appropriate option
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: V Gas ❑ Electric Electric Main Breaker Size (Residential only)
!,❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ U 0 O Q a •11
� V
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical Wm\%Y% S MechanicaM--z,--cam Plumbing
Framer-'-Ni- RoofingAC6.,-z\@...\ C -VCNrm%- Concrete
Solar Other
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.
Applicant Signature'-SQ �.�k`�. �c�41t\�r-tS.d'ti^ Print Name's is v► vt�e Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE