HomeMy WebLinkAbout4226 ROLLING GATE RD - APPLICATIONS - 12/20/2005BUILDING 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
APPLICATION NUMBER O f ` APPLICATION DATE ],, �k 0
Job Site Address 4ZZ(Q Row -,,sty, G A-ty., Rx, Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional)
Last NameSAAIK First Name_
Street Add
Phone #
Middle
State Zip
CONTRACTOR INFO: Company Name �Rn�1�► -1L"� �ZtaC.�Kll�Contractor Phone # 9 7D- ZZq-g %e
Lic. Holder Name tM �tS-nrc City of Fort Collins License #� Supervisor Cert #
Mailing Address ` L Mq City l..av ElArv� State_ Zip C6
LEGAL INFO:
City.
Subdivision/PUD THIE f24TFj AT- WceMOLiE Filing # 4TH Lot #--IA_ Block # Lot Sq Ft 9.4,74
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) ZI 7 Z-3 Total Garage Sq Ft (p93
Residential Sq Ft Z -17-3 Comm'I Sq Ft___JZ5 # of Stories_Z Bldg HeightZ: # Dwelling Units I (�
1 st Floor Sq Ft I , 3Z3 2nd Floor Sq Ft 14 C6 Unfinished Bsmt Sq Ft 1,323 Finished Bsmt Sq Ft V
# of Bedrooms 4 # of Full Baths Baths �_ 'V Baths �_ # of Fireplaces
Air Conditioning: (D� 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
Cityof Fort Collins Stock Plan # List appropriate option #s C1`
UTILITIES INFO:
Water Tap Size Sewer Tap Size _ Metered:5 or No Temp. Pedestal: a or No
Type of Heat: Gas ❑ Electric Electric Main Breaker Size (Residential only): )(150 Amp or Less ❑ 200 Amp ❑ Other
00
Value of Construction (including labor, material & profit) $ x
Description of Work: Al EW S 1 i (,G FAM I"
Contact Name & Phone # of JOBSITE SUPERVISOR: KEN 13ao&lbera% - --1 -7 lqqs
Subcontractor Info:
Electrical AbA Mechanical 1Plumbing �5
Framer TymNy p1A Roofing __ 60%-0 1400r,%k% Concrete \iAfZLAA.S 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 Fo Collins ordinances and state laws regulating building construction.
Applicant Signature Print Name 3110"* T1 Phone 5(07-14g5-
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE