HomeMy WebLinkAbout4380 ZIEGLER RD - APPLICATIONS - 10/16/2007Citv of Fort Collins
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
17
APPLICATION NUMBER &qy �2 O0 APPLICATION DATE 10� /y" �9
Job Site Address L4-3"3p z-jECLa_`(zfD -lTCwuNS CO Unit #
Phone #
PROPERTY OWNER INFO: (All owner information is required - it is not optional)
best Name f ameAVa,60 l'-nnNNVL-o Gie--S Fi *44ame
Middle
Street Address 43? w zd er--QZ� �l� City I t (f0(,U fj S State C-O zip
CONTRACTOR INFO: Company Name cO Contractor Phone # 7 �Vl �&
Lic. Holder Name \ �. City of Fort Collins License #� Supervisor Cert #
Mailing Address )qz�) L-I Ragq City �LI }l Z State CU zip
LEGALINFO: may,
Subdivision/PUD ��� - CZ�-`( Filing # Lot # Z Block # Lot Sq-Ft I AC.
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) 40,q Total Garage Sq Ft
Residential Sq Ft Comm'I Sq
1s' Floor Sq Ft
# of Bedrooms
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
# of Stories Bldg Height # Dwelling Units
2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Full Baths 3/4 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 N Sewer Tap Size N/� Metered: Yes or No Temp. Pedestal: Yes or No
Type of Heat: ❑ Gas L"Electric Electric Main Breaker Size (Residential only): ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ 0
Description of Work:rCA�
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical Diu I`�t= Mechanical
Z
Plumbing
Framer Roofing Concrete Other
Applicant: I hereby ackno dge that ave read this application and state that the above information is correct and agree to comply with all requirements
contained herein and e
ty of Fo lins ordinances and state laws regulating building construction.
Applicant Signature 4 ti Print Name Phone
D>tcibutibn: White -Office Yellow -Applicant Pink - WWW1Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE