HomeMy WebLinkAbout1117 Robertson St - Applications/Addition or Alteration - 02/10/2017COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. - Fort Collins, CO 80522-0580 - Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 1—001,00-7 APPLICATION DATE 2 lO
Job Site Address 1117 / 0 0bFe_IW S // Unit #
PROPERTY OWNER INFO: (All owner Information Is required - It Is not optional) Phone # /0 7
Last name 1 C C/7 s'r'CL s'--� First Name %11411� e x Middle 4� I)y L�
Street Address H / % IQD�T �� -5 City rv/��" �%��� � Sttate�Ce Zip VVJ _ /
CONTRACTOR INFO: Company Name 18&t/t1'Q %�/���/J1/'�}lV �%%� Contractor Phone Op - /7 7/-eq 56"ro
Lic Holder Name _ ]Q�y 41j City of Fort Collins License # Z'� Supervisor Cart #
Mailing Address ��%� �� Q� Cit State Co Zip
LEGAL INFO:
Subdivision/PUD
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
((
Residential Sq Ft `I OD Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1 s' Floor Sq Ft
2nd Floor Sq Ft
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 S. 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: N Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material 8 profit) $ 6 5-00, Oo
Description of Work: DC;*O 3O Lf, ZXy
A-ne r? ) L/iL 72,t_=wAvs- i9% A 1 — hav1,., ¢LL 7b oo::�04-11fr v-P i r�
Contact Name 8 Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electricalzbiek L'Zr��JYQIL Mechanical
Framer
Solar —"
-y7i-3aYyl
Plumbing
Roofing ^ Concrete Fireplace
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 F rt Collins ordinance nd state laws regulating building c�onn/sst�truuccttion.//__'' Q pa� /� p,t/
Applicant Signature Print Name /,7/1)t�ie� 4U1 AT9#- Phone lOw-WI 30ild
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE