HomeMy WebLinkAbout838 ROMA VALLEY DR - APPLICATIONS - 1/30/2007BUILDING PERMITS & INSPECTIONS DIVISION
ter" 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 O w� APPLICATION DATE
Job Site Address lit ffnye lletl k. Uniitit# M
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # q.tl/- 2c6- ruq
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Last Name 601A First Name R6cle,f Middle
Street Address 9s% Rom& \kt �r City .t`O w. State co Zip �05
CONTRACTOR INFO: Company Name
� NiilleAniurrx Basem S Contractor Phone# g7b-310-gOqQ
Lic. Holder Name -Pally ACg10.ir City of Fort Collins License # -�(0 Supervisor Cert t#�
Mailing Address yam{ Rrat_aladle �A City'51.(,^,�O►'(AS State �a Zip �$�S)z(
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft Comm'I Sq
1st Floor Sq Ft
# of Bedrooms
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
2nd Floor Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
Unfinished Bsmt Sq Ft ICO- Finished Bsmt Sq Ft i t CbO
# of Full Baths 3/4 Baths '/2 Baths
Energy info: (Circle appropriate choice) 1. ComCheck
4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing
List appropriate option
# of Fireplaces
2. ResCheck w/Air Sealing
6. Prescriptive w/Blower Door
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): ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ &C�r ®"d
n - -_-1 P. , i - LAI
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: // [ D 1 {� 1
Electrical AIli'atice L/eciriC- Mechanical r fLICAQ($2 Plumbing IZITf;C �o IAq
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 ordinances and state laws regulating building construction.
Applicant Signature Zaz Print Name9ar.1/ Acs Atr Phone 17b-316-4090
Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE