HomeMy WebLinkAbout5321 Old Mill Rd - Applications/Basement Finish - 03/15/2018City of II 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 APPLICATION DATE
Job Site Address .53 2 1 OLD M I L L KO Unit # --
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone #
Last name 2�I �First Name %�e►.� Middle No S S
Street Address ) 3 Z t p
1 OLn I t I LL 1 �. b City pot* ChUYtl s State—C (D zip 8 ().S-
CONTRACTOR INFO: Company Name Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cent #
Mailing Address City State Zip
LEGAL INFO:
Subdivision/PUD a &,ry eS+ Par 4 Filing # Lot #_-P— Block #_Ly__ Lot Sq Ft 10 d
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' Floor Sq Ft 2nd Floor Sq Ft 3'd 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 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
f(Residential only) X 15'OµAmp/^ou'r�Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) ($ ,U:� �TI 1` OJt �✓v 1.
Description of Work: fftoi@roy. 600 SgJA, bt ��SCN�evL} -6 bp- �o\.Is �ec�
1 . _ r`l1 . o , 1 1 .
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Mechanical
Roofing — Concrete
Other 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 Fort Collins ordinances regulating building construction.
Applicant Signature A A"w toL Print Name V iehok 0J-
Distribution: White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE