HomeMy WebLinkAbout424 W Mulberry St - Applications/Addition or Alteration - 07/27/2016Fort Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
www.fcgov.com/building
APPLICATION
Job Site Address q
1
APPLICATION DATE `T
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone
Last name C. 0, FG. First Name
Street Add
Unit #
Middle
CONTRACTOR INFO: Company'/Name /(:f'a1 %C C. Contractor Phone #
Lic Holder Name ar i at - t�W�aTt1 City of Fort Collins License #_
Mailing Address 3GY> rF2 ALx— City � C_
LEGAL INFO:
Subdivision/PUD Filing #,
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'I Sq
1s' Floor Sq Ft
Finished Bsmt Sq Ft
201 Floor Sq Ft
State Zip
Supervisor Cert #
State CO Zip Oy'T Z4/
Lot # Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths 3/4 Baths /2 Baths # of Fireplaces
Air Conditioning: Ye�]Non Energy info: ( Circle appropriate choice ) 1. ComCheck 11 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 # List appropriate option #s
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes ❑Noll Temp. Pedestal Yes❑ No
Type of Heat: ❑ Gas Electric Electric Main Breaker Size (Residential only) 1:1150 Amp or Less ❑ 200 Amp Other
Value of Construction (including labor, material & profit) $ /�
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Contact Name & Phone # of JOBSITE SUPERVISOR: �Z S 470 2(- 6Z73
Subcontractor Info:
Electrical-sj-aks Mechanical
Framer / t ✓1 c k Ta Roofing
Solar
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
ofins ordinances and state laws regulating building construction.
Applicant Signature Print Name C L� Phone
Ord,&- 0": q72Z7- (p op.o 3
GGta- g. 57,0107. 539999 Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
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