HomeMy WebLinkAbout604 CORNELL AVE - APPLICATIONS - 5/5/2006BUILDING PERMITS & INSPECTIONS DIVISION
` P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.conVbuilding
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER tl) APPLICATION DATE
Job Site Address (o D `l 6or'n, l C Ale, Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # qa2 -39y3
Last Name Ra b&e-b First Name kAys Middle 6a^emr,
Street Address 6o!i Coendl ,Ave,, City R ai/f�3 State —CO Zip d5;2$-
CONTRACTOR INFO: Company Name /V/l l Contractor Phone #
Lic. Holder Name
Mailing Address,
City of Fort Collins License #
City
LEGALINFO: j
Subdivision/PUD /� � SOA Filing #,
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residenkl Sq Ft Comm'I Sq
1st Floor Sq Fib 2nd Floor Sq Ft
# of Bedrooms
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Supervisor Cert #
State Zip
Lot # I - Block #--&— Lot Sq Ft V, 1 bD
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
_ Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft _
# of Full Baths % Baths '/2 Baths # of Fireplaces
nergy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
4. E-Star w er Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
Water Tap Size Sewer Tap Size
appropriate option
Metered: Yes-'w,_No Temp. Pedestal: Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only)NQ 150 Amp or Less ❑ 200 Amp ❑ (,ether
Value of Construction(includinglabor, material & profit) $ O� ��l `7 .0 732c(�i
Description of Work: P-mytodA / iL' l4e-k! /C,icky�g /1LN/ rG�,�,t,�� i'(�,•�
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Contact Name & Phone # of JOBSITE SUPERVISOR:
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 oof%%For_�tt, Collins ordinances and state laws regulating building construction. V
Applicant Signature I N1- ��� V� Print Name 1C �VS � b4y1 S Phone y Ool —31 y3
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE