HomeMy WebLinkAbout630 SMITH ST - APPLICATIONS - 7/25/2006BuiLDI NG PERMITS & INSPECTIONS DIVISION
PO Ekw SW • Fort Collins, CO W522-OW • Phone: 2U-6760
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City of Fwt conins BUILDING PERMIT APPLICATION
APPLICATION NUMBER ` 0 APPLICATION DATE r C�
Job Site Address
6 -,30 C�42 f`-j S4zee4- Unit # ----
PROPERTY QVME.,RI,NFO:
(All owner informatiaon is required - it is not optional) Phone # q �o - �Xa- q c 5 �-
Last Name 5I al^
w✓lC.-tI First NameMiddle S
Street Address �1,50
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S/r%/7�1 ��� City [l �� COiV%,S State CO Zip iFC�,S'Z�%
CONTRACTOR INFO:
Company Name Contractor Phone #
Lic. Holder Name
City of Fort Collins License # Supervisor Cert #
Mailing Address
City State Zip
Subdivision/PUD
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Filingk_______= Lot # Block # Lot Sq Ft
CONSTRUCTION INFO:
Total Building Sq Ft (not including basement) Total Garage Sq Ft 3 30,
Residential Sq Ft
Comm'I Sq Ft -- # of Stories Bldg Height " # Dwelling Units
1A Floor Sq Ft _
2nd Floor Sq Ft — Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft .r
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# of Bedrooms '—'
# of Full Baths % Baths — % Baths ^ # of Fireplaces —
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Air Conditioning: Yes V 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
tUrN.ITIESINFO: / /(
Water Tap Size N A- Sewer Tap Size L `! Metered: Yes or VI o Temp. Pedestal: Yes or
Type of Heat: O Gas 0 Electric Electric Main Breaker Size (Residenti nly): 0 15O Amp or Less 0 200 Amp F ther �/c kn t✓
Value of Construction (including labor, material & profit) _ ..
Description of Work V, e-C k` S -k a� ol« v d Y C 3 - h �S p5 Ne'% {1^ O k � OA OI k
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Contact Name & Phone # of JOBSITE SUPERVISOR: CC V-- D
SubrAmbactclir Info:
Electrical ~� Mechanical
Plumbing
Framer Roofing Concrete Other
Applicant: I hereby acknowledge that 1 have read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort Colli ordinan and s laws ulating building construction.
Applicant Signature Print Name s � S S finke �c �(n Phone ct?O �2 - c{ (5.)-
Dist ' lon�AI
White - Office Yellow -Applicant Pink - WWWIStormwater
THIS APPL ONEXPIRES 90 DAYS FROM APPLICATION DATE