HomeMy WebLinkAbout1727 Rolling Gate Rd - Applications/Basement Finish - 01/04/2017City off I 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
APPLICATION NUMBER FDj—1 V W 2% APPLICATION DATE 1 14I zo I —I
Job Site Address 17 A-7 'Fo 1l ingocte. Ford- Coll ►V1S Unit #
PROPERTY OWNER INFO: (All owner information is required — It Is not optional) Phone # 306 — 13 `)1 _
Last name Iv \Q�I t°a�- First Name oJoh n /� Middle
Street Address I �� I� Q1 1 lY1 Q �'P _ City FOC-V W 1 t 05 State CO zip S0526
CONTRACTOR INFO: Company Name KIA I I?�'15 tc ► U,1 ii, Contractor Phone # 3 IO ' (p 4-1ej-j
Lic Holder Name 2Al Kin I ensK t y City of Fort Collins License # c a & 5 Supervisor Cart #
Mailing Address Q;1 "l V l , .K S"I City F01�± W \ 1 { 0.5 State W zip. 0 0 5 ,Z 1
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'I Sq
1S1 Floor Sq Ft
2nd Floor Sq Ft
Filing # Lot # Block # Lot Sq Ft
ement) Total Garage Sq Ft
_ # of Stories Bldg Height # Dwelling Units
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft II b In . # of Bedrooms I # 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 Temp. Pedestal Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $
Description of Work: \ 1 3 (o S F 501 SC , Vn Cn + Jr t n t $ it Co n S t 5 +, n A o,�
Fie -A room Fq mI Iv R nom and 3/4 13a+h
Gtnri F-tre-P IaCP
Contact Name & Phone # of JOBSITE SUPERVISOR: At K u \ en -SK t 3 I i7 — b
Subcontractor Info:
Electrical A K
1 C'G+(-t C I ft Mechanical A
Te ann
Plumbing G loraao
1' am b to Q
Framer
Roofing
Concrete
Fireplace
Solar
Other
Other
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 dinances and state laws regulating building construction. 1� Q
Applicant Signatur�`��� Print Name M KUl en SK 1 Phone 3 6 �t 03
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE