HomeMy WebLinkAbout6107 MELROSE CT - APPLICATIONS - 12/5/2005r BUILDING 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
I APPLICATION NUMBER 1.
B OM-� C C " APPLICATION DATE
Job Site Address Q (0 1 "fi( I -()SC Unitq#
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone # / -?0— 4gq— 9
Last Name Bib 6yo b First Name �1�e, l Middle A.
Street Address LJ A -1- I R— �I2.o Sd CT ,�a
City !-1 �v l 1, N S Statej�4—_Zip O �LS�
CONTRACTOR INFO: Company Name e. I Contractor Phone #
Lic. Holder Nam
Mailing Address_
LEGAL INFO:
Subdivision/PUD
City of Fort Collins License #.
City
Filing # Lot #
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Supervisor Cert #.
State Zip
Block # Lot Sq Ft
Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
15f Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq FtFinished Bsmt Sq Ft �3 5ZO
# of Bedrooms # of Full Baths 3/ Baths '/z 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 #
UTILITIES INFO:
List appropriate option #s
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal: Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only): ❑ 150 Amp or Less 11200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ 62dr ),3
Contact Name & Phone # of JOBSITE SUPERVISOR: / �%/L J31�
Subcontractor Info:
Electrical
Mechanical
Plumbing
Framer Roofing Concrete Other
Applicant: I hereby acknowledge 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 of F Collins ordinances and state laws regulating building construction.
Applicant Signature Print Name��������� Phone292-6e
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE