HomeMy WebLinkAbout5332 S Timberline Rd - Applications/Shed - 10/16/2017COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
APPLICATION
Job Site Address
(All
Last name 7 1
Street Address
CONTRACTORINFO
Lic Holder Name
Mailing Address
LEGAL INFO:
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
www.fegov.com/building
BUILDING PERMIT APPLICATION
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APPLICATION DATE U — I V - 1
Unit #
wrier Information is required - it is not optio 1 Phone #
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First Name Middle
Ci / -2 S State Zi
ame _�/7 Contractor Phone # tq-10—cP13
> d City of Fort Collins License #_ Supervisor Cart #
City 12 /i2 State Zip_
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 Ft # of Stories Bldg Height # Dwelling Units
1 n Floor Sq Ft
2nd Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths '/z Baths # of Fireplaces
Air Conditioning: Ye& Energy info ( Circle appropriate choice ) 1. ComCheck ❑ 2. ResCheck w/Air Sealing ❑
3. ResCheck w/Blower Door n
4. Simulated Performance Alternative❑ 5. Prescriptive w/Air Sealing ❑ 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan # List appropriate option #s
Water Tap Size Sewer Tap Size
Type of Heat. F1Gas ❑Electric Electric Main Breaker
Value of Construction (including labor, material & profit) $
Description of Work
Contact Name & Phone # of JOBSITE SUPERVISOR:
Metered Yes l:]Nol:l Temp Pedestal Yes❑ No ❑
e (Residential only) 1:1150 Amp or Less ❑ 200 Amp DOther
Subcontractor Info: A, p
Electrical /" Mechanical /� Plumbing A4
Framer Roofing Concrete.
Solar Other Other
Fireplace
Other
Applicant I hereby acknowl a that I have isa cation and state that the above information is correct and agree to comply with all requirements
contained herein and City 74�
finances state laws regulating building construction /� � /�/��j/Applicant SignaturePrint Name l/Cs�! Phone (/ ` �� / G t� -
Distribution White - Office Yellow - Applicant Pink - WWW/Stonnwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE