HomeMy WebLinkAbout411 S BRYAN AVE - APPLICATIONS - 4/6/2009i BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building " il
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER y' APPLICATION DATE
Job Site Address q / ► S O UTI 7� r U az^. AV`C,- Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional)
Last Name G r u First Name
Phone #
Middle
Street Address-� d d LA f V1'f-lz 1 V e City FCC State / aZipS T�
CONTRACTOR INFO: Company Name L r C D lo?iYnA ft' a-u�iS �""cont-ractor Phone # OL�I `b '(T J
Lic. Holder Name e)e e-)IU City of Fort Collins License # C 1 ���3 ,`\\Supervisor Cert #�/,
Mailing Address , � Oc City 'C9'l l�0 II�S State W Zip �c�. 4
LEGAL INFO:
Subdivision/PUD
Filing # Lot #,
CONSTRUCTION INFO: Total Building Sq Ft (nN,Cncluding basement)
Residential Sq Ft Comm'I Sq Ft
1st Floor Sq Ft
# of Bedrooms
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft _
# of Full Baths Baths '/2 Baths # of Fireplaces
Energy info: (Circle appropriate nice) 1. ComCheck 2. ResCheck w/Air Sealing
4. E-Star w/Blower Door 5. PrescripXe w/Air Sealing 6. Prescriptive w/Blower Door
List appropriate option
Water Tap Size Sewer Tap Size Metered: Yes or No \
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residegtial only): ❑ 150
Value of Construction (including labor, material &profit) $ L+ co-�
Temp. Pedestal: Yes or No
or Less ❑ 200 Amp ❑ Other
of Work: r/ E ► r w l w d . ale) .P x Ls% rryg s he/IlPh/'s (And (t�0 j j S } l�'U C�r� 11 Plvj
moo , 2 Ot? 5U4 101
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical A/?�' Mechanical /Vpf— Plumbing ?rPF-
Framer 005 Sel VIC-CS Roofing 0-2�S SerV I C�P--S Concrete 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 Ci of Fglrt Collins dinances and state laws regulating building construction.
Applicant Signature r� Print NameSTII y'5 �F"LD Phoneao
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE