HomeMy WebLinkAbout511 Mathews St - Applications/Addition or Alteration - 08/01/2018City 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
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APPLICATION NUMBER �1 ) U 2-1 q APPLICATION DATE 16 11 I L `-'
Job Site Address
Unit #
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone #
Last name .L First Name (>,,jV P/ Middle Cr
Street Address :,) ( ( M QAI lec'z City rf. . r6 (' 1 n T State_C0Zip —t
CONTRACTOR INFO: Company Name Contractor Phone #
Lic Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
City of Fort Collins License #.
City.
Supervisor Cent #_
State Zip
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Z-!�O Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1$1 Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
31 Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths 3/4 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 #
UTILITIES INFO:
List appropriate option
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 ❑ 20o Amp ❑ Other
Value of Construction (including labor, material & profit) $ 12
of Work: — � t1Sj:)Q—c- 1 G
Electrical M uAkk%v O `^-"' a- Mechanical
Framer
Roofing
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7.
Mom:
Plumbing
Concrete
Fireplace
Solar Other Other '� Other
Applicant: I hereby ac o ledge that I have read this application and state that the above information is correct and agree to comply with all requirements
contained herein and Ci of Fort Collins rdinances and state laws regulating building construction.
Applicant Signature Print Name Phone Jx)"
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Distribution: White —Office Yellow —Applicant Pink — WWW/Stormwater v
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE