HomeMy WebLinkAbout631 N BRIARWOOD RD - APPLICATIONS - 3/20/2009BUILDING PERMITS SL INSPECTIONS DIVISION
P.O. Boxb80 • Fort Collins, CO 80522.0580 • Phone: 221-6760
www.kgov.com/building
Citv of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER (J �D /V APPLICATION DATE 2T—O^r
Job Site Address, _ � Unit #
PROPERTY OWNER INFO (All owner information is required - it is not, optional) Phone # - �C� ?" ® 6 Z�
Last Name First Name /yi' W1(1q tFL Middle
Street Address City State zip
CONTRACTOR INFO:. Company Name �c � s 0�!/'V//& Contractor Phone # - !K > 9
Lic. Holder Name /Q �t� City of Fort Collins License # DZ_S Supervisor Cert #
Mailing Address-� N L%/U/� �/7 76 City )XT State. 6y, zip- S2�
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Z2 f _ _. Total Garage Sg Ft _
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1st Floor Sq Ft
2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Bedrooms # of Full Baths _ ___ _ _ _ __ % Baths _- 'Y2 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. E-Star w/Blower Door 5-Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door l
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): 0 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ � ! 3 2 _ -
Description of Work:29/� co Gl/� co Aar —
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Mechanical - . _ . Plumbing
Framer Roofing -"'" 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 City of Fort Collins ordin ces and state laws regulating building construction. Applicant Signature .Print Name Phone %�y���19
Y
Distribution:. White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE