HomeMy WebLinkAbout3144 Lower Loop Loop Dr - Applications/Basement Finish - 03/20/2017COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
City of
Fort Collins
APPLICATION
Job Site -Address
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
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APPLICATION
Unit #
PROPERTY OWNER INFO: (All owner information Is required - it is not optional) Phone # 0170 t5f97 - 7-5 `p
Last name /F q
First Name
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Street Address
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City �da'�- 6011 ^/1S
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State�Zip C p0S� /
CONTRACTOR-1 KEQ:
Company Name (7rr`_Y,
Contractor Phone #
170-670 -
Lic Holder Name
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City of Fort Collins License #
Supervisor Cert #
Mailing Address
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City t!A /P- State
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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 Comm'I Sq
# of Stories Bldg Height # Dwelling Units
ls' Floor Sq Ft "d Floor Sq Ft 3'd Floor Sq Ft '�'Unfiished Bsmt Sp Ft-> S
t oomsq FBaths- '/: Baths? #_of_FireplacesFinished Bsmt S#
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Air Conditioning: Yes No Energy info: ( Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
Water Tap Size Sewer Tap Size
Type of Heat: ❑ Gas ❑ Electric Electric Main
`Value of Construction.(including-labor,-material 8profit)_3
List appropriate option #s.
Metered: Yes or No Temp. Pedestal Yes or No
r.Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
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`Con_ tact Name 8 Phone # of JOBSITE SUPERVISOR -
Subcontractor Info:
Electrical Cto�44pv-c,:�;"G4^`�Mechanical /' lttr - r Plumbing kivd,
Framer
Solar
Roofing
Other
Concrete
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 Coll' r ' ances and state laws regulating building construction.
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Applicant Signature..... Print Name � `Phone gZD—C�70— /4l�
Distribution: While — Office Yellow — Applicant Pink — WWW/Stonnwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE