HomeMy WebLinkAbout615 ROMA VALLEY DR - APPLICATIONS - 9/17/2007BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 �?
www.fcgov.com/building 3a. LlJ
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 1Jl: qO f%APPLICATION DATE
Job Site Address
it #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # �p �p'�O
Last Name Lt kiz!; �.t' First Name �1
Middle
Street Address City 2) �O
State Zip S
CONTRACTOR INFO: Company Name �� . 27o Contractor Phone
Lic. Holder Name l 1144C /(✓j f y Supervisor Cart #
//�-l!,-.�_,(�.rCity o Fort Collins License #
Mailing Addressy�J� s�s Aity ��-rp�t/� State 4� Zip
LEGAL INFO:
Subdivision/PUD Filing Lot #
CONSTRUCTION INFO Total Building Sq Ft (not including basement 5
Residential 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
Total Garage Sq Ft
Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Full Baths 3/, Baths % Baths # of Fireplaces
Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
4. E-Star w/Blower Door 5. Prescriptive 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 (Residential only
Value of Construction (including labor, material & profit)
Description
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Temp. Pedestal: Yes or No
❑ 11550/Amp or Less
I! T q 00
❑ 200 Amp ❑ Other
A?-- -�i dd �Pf-
Plumbing
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 F s ordinances Py stag regulating building construction.
Applicant Sign Print Name6424!:e PhonW_ dS
Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater
Roofing
Mechanical
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE