HomeMy WebLinkAbout420 Galaxy Way - Applications/Addition or Alteration - 01/31/2017City of I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort+t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
wvvw.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 11b) V n APPLICATION DATE I� ' 'IF
Job Site Address WO cfalay\I akl Unit # ,
PROPERTY OWNER INFO: (All owner information is required— It is not o�p�tionaPh l one # G70 - Z R-6 I/ 1 Q
Last name Qu 1n S First Name 1 �-tCil/lUl Middle
Street Address Q-ZC2 Galax( W (r��/ City I�r f �OII � nS State (0 Zip FO-7,5'
CONTRACTOR INFO: Company Name Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address City State Zip
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) 200 Total Garage Sq Ft
Residential Sq Ft7� Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
ls' Floor Sq Ft n h 00 2"d Floor Sq Ft 3`d Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths '/, Baths '/2 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 # List appropriate option #s
UTILITIES INFO:
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: }-Icldyk Qc1 roo r
ra(I �C(A Ic p W P o,9 DLA • Vi L') G rk .
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical Mechanical
Framer
Solar
Roofing
Other
Concrete
Other
0'4)
�
Plumbing
Fireplace
Other
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Applicant: I hereby acknowledge that ]pave read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of ort CollWordin, cesand state laws regulating building construction.Applicant SignaturePrint Name : -em Ni 0t) i� S. Phone 97d Z31-r`
Distribution: White — Office Yellow —Applicant Pink—WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE