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HomeMy WebLinkAbout4123 VERBENA WAY - APPLICATIONS - 9/10/2007BUILDING 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 B 0 / V ( / 0 APPLICATION DATE [ —1 Oy Job Site Address ¢123 U61 LUA^,r Unit �#-7 (44) R PROPERTY OWNER INFO: (All owner information is required t is not optional) Phone # l 3 - - L 2: i. k(58 Last Name CC, CAV-jW l �,t', ' o^f � //++� ©LtVeTL- Middle �, Street Address L ftrap& s 19L• "lo& Citkgew jpcy UL� c�State lJ� Zip CONTRACTOR INFO: Company Name Lic. Holder Name Mailing Contractor Phone City of Fort Collins License # Supervisor Cert # City. State LEGALINFO: /_ / D Subdivision/PUD QTo4`160 (A 9U�15D Filing # Lot # 7` Bloocck # �o( q Ft -� CONSTRUCTION INFO: Total Building Sq Ft (not including basement) ' .4� 22 ci' -otal Garage Sq Ft I to y I Residential Sq Ft Uo.113k Comm9 Sq Ft # of Stories 9 9 2)9. 9 3 • -Bldg Hei ht 'tQ # Dwellin Units 1sl Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq Ft N h Finished Bsmt Sq Ft PA # of Bedrooms 15� 4- . # of Full Baths '/< Baths /2 Baths # of Fireplaces Air Conditioning: Yes No Energy info: (Circle appropriate choice) QESc 2 heck 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 # UTILITIES INFO List appropriate option if It Water Tap Size '2� Sewer Tap Size 6 Metere .Yes r No Temp. Pedestal: Yes or No Type of Heat: XGas ❑ Electric Electric Main Breaker Size (Residential only): ❑ 150 Amp or Less ❑ 200 Amp ❑ Other Value of Construction (including labor, material & profit) $ 0�)_ SW Colo Description of Work: Czl e �,�� gipr r 4-LI-lumT ►gFA'Q4 VVtE1,r -tU ILPa,36 Contact Name & Phone # of JOBSITE SUPERVISOR: Subcontractor Info: Electrical Framer Roofing Mechanical Concrete Plumbing Other Applicant: I hereby acknowledge that I e read this application and state that the above information is correct and agree to comply with all requirements contained herein a d Ci f Fort Col'ns rd ances and state laws regulating building construction. r� Applicant Signatur Print Namegjo/(E� ©cAVM_ Phone3'3, & 16 Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE