HomeMy WebLinkAbout924 W Mountain Ave - Applications/Addition or Alteration - 02/02/2017City of I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
�t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER v v "l v ` APPLICATION DATE �2
Job Site Address , '1 Zy W # Mau i) r i �j NV E Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 91 7 —5 38 - T63
Last name S `+FIZp First/Name 1AI l�Srp IJ Middle A
Street Address 9Zq I/1 • hja/ &..l-r141&3 AV F City (^ T C.�1�10S State CoZip A05Zl
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Contractor Phone
City of Fort Collins License #
City
Filing # Lot #.
Supervisor Cart #.
State Zip
Block # Lot Sq Ft
Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1 s' Floor Sq Ft
Finished Bsmt Sq Ft
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
RA> Akfl=&31N1*]R
2nd Floor Sq Ft 3'd Floor Sq Ft Unfiished Bsmt Sq Ft
# of Bedrooms --0— # of Full Baths % Baths -95A % 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 #s
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) _$ EST tW1Ar/—t— 1-45n��
PD[_1GF T (Z to+ 1i� 3t - F r� c� CZY�2 r-n 4 �S�T �nS ir�14r.Y ar) t7 C Z) AUa t� -
n.n, -r`
Gt-PSE"f ' (� P-IA(a �rG ri4[1 I N �t�4TFtf2l�sn� jt r Vw�IT
Contact Name & hone # of JOBS ITE 5 ERVISOR:
Subcontractor Info: $fn�7 �lUhnbMy -t 1AC*(T
Electrical Mechanical Plumbing I`Y W tJ I—T�. ��
Framer
Solar
loofing Concrete
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
Print Name
Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE