HomeMy WebLinkAbout3400 Sam Houston Cir - Applications/Basement Finish - 03/20/2017City of II 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
RR
APPLICATION Ng1MBE� APPLICATION DATE 3 _20 -_l
Job Site Add
2
Unit #
c)A Co � I 1, on� Co �o S
PROPERTY OWNER INFO: (All owner informationis required - it Is not optio1na hone #
Last name Jm , First Name Middle PG V k e Y"
Street Address QV S. C J City FO M CU1\' )S State —cc —)Zip S%�
CONTRACTOR INFO: Company Name
Lic Holder Name
Contractor Phone #
City of Fort Collins License # Supervisor Cart #
Mailing Address City
LEGAL INFO:
Subdivision/PUD
Filing # Lot #.
State Zip
Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1s' FI or S Ft 2ntl Floor Sq Ft 3itl Floor Sq Ft nfiishe smt Sq Ft L
jesmt Sq Ft_( # of Bedrooms �_ # of Full Baths �_ '/. Baths Q /z Baths Q' # 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 BrTker Size (Residential only) ❑ 150 A(mpp or Less ❑ 200 Amp []Other
Value of Construction (including labor,' material & profit)-$�, lCU ./• uo
Description of Work: JGir^: (\N
\5
A
Contact Name & Phone # of JOBSITE SUPERVISOR: %7.0 - 2 11 - y±4+- r AJa"1, -S,, I
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
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 of F ollins ordinances and sta laws regulating building construction. � / �')
(`Applicant Signature tint Name /Vq Itng�l� S�,r ri-� Phone /L�'217- 7�TT7
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE