HomeMy WebLinkAbout901 W MOUNTAIN AVE - APPLICATIONS - 12/4/2009BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER 00 q01 APPLICATION DATE /C9 - Ll 40 /
Job Site Address C4 0) M Avo, Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # L4 43 Oq S-O
Last Name H b First Name On, Middle 9
Street Address ClD 1 j4j . M U City_' A5, ran I / 1 nS State GD Zip $052
CONTRACTOR INFO: Company Name Contractor Phone #
Lic. Holder Name of Fort Collins License Supervi ert #
Mailing Address City State Zip
LEGAL INFO: 1 II i -
Subdivision/PUD �QOUSA I nQbn P'GC(j�- Filing # Lot # Block #— Lot Sq Ft 6 Sa
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft (7
fah
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height$.s # Dwelling Units
1st Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Bedrooms -5 #,,of Full Baths % Baths '/2 Baths I # of Fireplaces ci _
Air Conditioning: Yes ( Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. E-Star w/Blower Door 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 NoTemp. Pedestal: Yes or No
Type of Heat: 121 Gas ❑ Electric Electric Main Breaker Size (Residential only): /150,Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including la or, material & pint) $ l � Q ° 6
Description of Work: / /� Ct�I ✓1 I
5I r L, l Ll nay'
P
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: ,r�o�e, Adle
-T � l Electrical WAm UP EL -I ` Mechanical jJ Plumbing
Framer Roofing'eacxy Mrt�l Roopep-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 ity of Fort Collins ordinances and state laws regulating building construction. ' I
Applicant Signature Print Name QeD4j^ 2 Na" h Phone q::?0 44,3095-D
UD ribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THM APPLICAMN IE1iG' MES 90 DAYS FROM APPLICAMN DATE