HomeMy WebLinkAbout826 Jerome St - Applications/Single Family New - 08/29/2017 (8)City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rt Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
www.fcgov.connu%ulidl ng
BUILDING PERMIT APPLICATION
APPLICATION NUMBER APPLICATION DATE_ _ _ ?g I O
Job Site Address!P)a 6 �ivSt.orn2 Unit #_
PROPERTY OWNER INFO, (All owner Information Is required- it is not optional) Phone # j1-jk7
Last name � trt�t a -�iKX� , ll-L First Name Middle
Street Address oC I t< 6-• uaXL dr' City-)i-pe-, - CV1jjr ,S pState17 Zip �Usa
CONTRACTOR INFO: Company Name 11 a,2ccr� CA-r,,5AIl4.t b-Contractor Phone # �t
Lic Holder Name �A'19e--p 1Q4L I �1�as
��t� City of F-oort Collins License # a40a Supervisor CertV# IOYi /J
Mailing Address lyly AUL�[ �+tL4�_� -ic-1! City t'DL'� ���tM7 State Tip 6�!Z
LEGAL INFO: -tombi
Subdivlsion/PUD �L� 1 -o in +, ►✓i�� Filing # Lot # Block #�_ Lot Sq Ft
tal B, Harkin.+ c.. Ft (not including basement)_ 40 Li Total Garage Sq Ft
1 I
Residential Sq n p� Q Comm] Sq Ft # of Stories_ Bldg Height 3 J # Dwe11in Units —�
10 Floor Sq Ft 656 2n0 Floor Sq Ft q:X-1 3i° Floor Sq Ft X!oO
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths '/. Baths /2 Baths _ _# of Fireplaces_
Air Conditioning: Ye y AINo Energy In/o: ( clrn/e appropriate cholce) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. Simulated Performance Alternative❑ 6. Prescriptive w/Air Sealing S. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan ##JJJ = S e- List appropriate option #s CLZer~ Sul
UTILITIES INFO:
021�?. 't(of-,5 #13
Water Tap Size 3 l� Sewer Tap Size Metered: Yes �NoF] Temp. Pedestal Yesl No
Type of Heat Gas ❑Electric Electric Main Breaker Size (Residential only) W150Amp orless E]200Amp ❑Other
-I2-1, t 6
Contact Name 8 Phone # of JOUSITE SUPERVISOR:
Subcontractor Info: .�I `nJ
Electrical IJiLIAt/�it5 GI� �- Mechanical 1 ti4y- Plumbing TI S1 ,
11
Framer 1� Roofing �,La,00 Lr ncrete 4 C Q er — Fireplace _tAye 4&411c; �IeAo
Solar Other Other 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 C Fort Collins ordinances and state laws regulating building construction.
Applicant Signature Print Name —btfWt-(3*j0IJ Phone ?.70-4e2-
S9 yy
Distribution: White -Office Yellow -Applicant Pink -WWW/Stomrwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE