HomeMy WebLinkAbout4380 ZIEGLER RD - APPLICATIONS - 10/16/2007 (2)6a
City of Fort Collins
APPLICATION NUM
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION
i t In -�
Job Site Address F-D 'f I CO Unit # c�
Phone# 62-�p02;IyLt
371 &%34
PROPERTY OWNER INFO: (All owner information is required - it is not optional)
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City 1 1 (fGL-c-41� i State CO zip S"�
Street
Middle
CONTRACTOR INFO: Company Name '1Gf� Contractor Phone # 2,c�g / 1�
Lic. Holder Name r �. /City of Fort /C�oollins�License # �"dr0 Supervisor Cert/##
6LC
Mailing Address Cf %� ��� 1/eNIA�I City d t�C m"' State (�Q zip
LEGALINFO: - 7
Subdivision/PUD 1 f-t� �(L �`, Filing #� (_� /Lot # L--
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) �-�9J6
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 #
Block # Lot Sq-t- 101 Ac,
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Full Baths % Baths '/z 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
UTILITIES INFO:
Water Tap Size Sewer Tap Size
List appropriate option
Metered: Yes or No Temp. Pedestal: Yes or No
Type of Heat: ❑ Gas lectric Electric Main Breaker Size (Residential only): ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
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Value of Construction (including labor, material & profit) $ /0y 01�y /
Description of Work: � �/� L �� 5TS- Gam P4l.l t l 411
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical y L/���= Mechanical
Framer
Roofing
Concrete
Plumbing
Other
Applicant: I hereby ack7!d� that I ave read this application and state that the above information is correct and agree to comply with all requirements
contained herein and�f ns ordi sad state laws regulating buildin onstr ction. p 2
Applicant Signature Print Name�tTI/p�/ Phoneme?0 QJy7
Dis r i White - Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE