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HomeMy WebLinkAbout4123 VERBENA WAY - APPLICATIONS - 10/10/2007BUILDING PERMITS 8t INSPECTIONS DIVISION P.O. Box 580 •Fort Collins, CO 80522r0580 • Phone: 221-6760 6a www.fcgov.com/building CityofFortCollins BUILDING PERMIT APPLICATION APPLICATION NUMBER N " Y `� W 9 �� APPLICATION DATE `©� U ©— D ri Job Site Address 4423 Uozee'YJPr U)AY Unit # �a�Af/hE 14 PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 30 � -71,rL 60 06 Last Name �� UtI�C(�Orl(.�( �- (, �P0- �/� QL�y�!�- r I-PaHddte- Street Address 735D �, f �?�DSS'[�L City tJ� W� V ��& State�.Zip801 _ CONTRACTOR INFO: Company Name Lic. Holder Mailing LEGAL INFO: Contractor Phone # City of Fort Collins License #_ City Supervisor Cert #, State Zip Subdivision/PUD i[Uy c to SL%rp, Filing # Lot # Block # Lot Sq Ft 70 L�d'Qvv S CONSTRUCTION INFO: Total Building Sq Ft (not including basement) �'(to St Total Garage Sq Ft 0 Residential Sq Ft "— Comm'I Sq Ft # of Stories Bldg Height l3 # Dwelling Units 1st Floor Sq Ft "- 2nd Floor Sq Ft '— Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths /z Baths # of Fireplaces Air Conditioning: Yes CR Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing �Jl� 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 # l *78 f List appropriate option #s ' UTILITIES INFO: Water Tap Size Sewer Tap Size Metered: Yes o 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) $-70D Description of Work: S-'Brw P Ib^ Contact Name & Phone # of JOBSITE SUPERVISOR: Subcontractor Info: Electrical Framer Roofing Mechanical Concrete Plumbing Other Applicant: I hereby acknowledge that I a read this application and state that the above information is correct and agree to comply with all requirements contained herein a of Fort Collins ordi nces and state laws regulating building construction. Applicant Signatur Print Name VW ()LLVE11- PhoneX3. 9638 Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE