HomeMy WebLinkAbout4307 MILL CREEK CT - APPLICATIONS - 12/15/2006BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
(m6�� www.fcgov.com/building
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER i(J V (D t / v / `' APPLICATION DATE /
Job Site Address 4130q M I H Oa#-k ( -� Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # Last Name t-ctwlri First Name DII-,, �p Middle bljd[16r>'
Street Address 'q 3 ()I i^ 1 I I 1 e r c t �= yC] � City PO4 ` I �j r�� State �f 0 Zip ea'fzg
CONTRACTOR INFO: Company Name �/{ Contractor Phone #
Lic. Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address_
LEGALINFO:
Subdivisi /PUD
CONSTRUCTI
Residential Sq Ft _
1 sc. Floor Sq Ft _
# of Bedrooms
City
Filing # Lot #
Total Building Sq Ft (not including basement)
State
Block # Lot Sq
Total Garage Sq Ft
_ Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
Air Conditioning: Yes No
2nd Floor Sq Ft Unfinished Bsmt Sq Ftinished Bsmt Sq Ft
of Full Baths 3/4 Baths /z Baths # of Fireplaces
ergy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4.
City of Fort Collins Stock Plan #
UTILITIES INFO:
Water Tap Size Sewer Tap Size
Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
List appropriate option #s
Type of Heat: ❑ Gas ❑ Electric Electric Main Breake
Value of Construction (including labor, material & profit) $
of
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Mechanical
Metered: Yes or No Temp. Pedestal: Yes or No
(Residential only): ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
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 annof Fort Collyinns�ordiiJnances and state laws regulating building construction.
Applicant Signature _ 6/�C61 (�/ Print NamW� I 2, t c) tg, Phone Z zS��+`7� 19 �
Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater Z�rY�Q Z6v
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE