HomeMy WebLinkAbout613 N BRIARWOOD RD - APPLICATIONS - 8/25/2008BUILDING PERMITS & INSPECTIONS DIVISION
ia 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 V� Ot/�' 13 / APPLICATION DATE lay/o I
Job Site Address Unit # —
PROPERTY OW IER INFO: (All owner information is required - it is of optional) Phone # q '- a[�
Last Name dI�Z First Name
Middle
Street Address I �) �� I �2L�ac0 I� City ,
S state CO Zip_POS2I
CONTRACTOR INFO: Company Name
Lic. Holder
Mailing Address -
Contractor Phone #
City of Fort Collins License #
Supervisor Cert #
State - Zip
LEGAL INFO:
Subdivision/PUD pwoQr Filing # Lot #
Block # Lot Sq Ft
CONSTRUCTION INFO Total Building Sq Ft (not including basement)
Total Garage Sq Ft
Residential Sq Ft Comml Sq Ft # of Stories
Bldg Height # Dwelling Units
ls' Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt S Ft
4 Finished Bsmt Sq Ft
# of Bedrooms # of Full Baths '/, Baths
/2 Baths # of Fireplaces
Air Conditioning: Yes No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck 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 # List appropriate option #s
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes or No
Type of Heat: ❑ Gas ❑ Electric
Temp. Pedestal: Yes or No
Electric Main Breaker Size (Residential only): ❑ 150 Amp or Less
Value of Construction (lipluding labor, material & profit)
Description of Work: OuI L-r Stv-P op LP
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Mechanical
Concrete �U 1ef
Applicant: I hereby acknowl dge 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 or Collins rdin ces and state laws regulating building construction.
Applicant Signature uot�` A.) G-AWAGEV-`.Print NamePhone �-1 b D f
Distribution: hite - Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE
-V IO
Plumbing
❑ 200 Amp ❑ Other
Roofing