HomeMy WebLinkAbout119 N Shields St - Applications/Addition or Alteration - 03/22/2018City of
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
/ www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER \ ' W Y /��n1 APPLICATION DATE ?) ZZ
Job Site Address Unit # G
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name /� d 1First Name , L I i �` Middle
V 1� e
Street Address -al / = I -,/ City 1 T7 Ca
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CONTRACTOR INFO: Company Name O �'\I 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) Total Garage Sq Ft
Residential Sq Ft °L Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
ls' Floor Sq Ft 2n' Floor Sq Ft 31d Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths 1/4 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
i 1-n
Value of Construction (including labor,
Contact Name 8 Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Mechanical
Roofing
Other
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknow at I have read this application a d state t t the above information is correct and agree to comply with all requirements
contained herein and Cit of Fort Ilins or ' antes and to laMulailding cons ruction. //., ►y�v q /1/;
Applicant Signature ame LAke.y I. 1 6C Phone q�l J- S"1 / -355�Y
Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE