HomeMy WebLinkAbout424 W MOUNTAIN AVE - APPLICATIONS - 9/19/2012City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
FOIt+t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
/ www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER . I �V ` c/ I fr APPLICATION DATE i / _( ` ' 1 Z
Job Site Address y G lit/_ /yl cu t-�rLt Unit # -6P �/ /
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #C1 7 O� yI aZ�
Last name Cjcj(C-H-
I / , - A First Name �^ \ r t Middle
Street Address (,`7 W - / ✓/ GlM t In City i'7e-'t- �d l (t- g State CC) Zip_Lks�l 1
CONTRACTOR INFO: Company Name Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cart #
Mailing Address City State Zip
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm] Sq Ft # of Stories Bldg Height # Dwelling Units
151 Floor Sq Ft 2nd Floor Sq Ft t � 3'd Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms 7 # of Full Baths Z 3% Baths Yz Baths i # of Fireplaces 1
Air Conditioning: Yes No Energy info:( Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. Simulated Performance Alternative 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 Metere es r No Temp. Pedestal Yes or No
Type of Heat: ff6as ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ 71DOO
Description of Work: ( 1 Al. ` - �4 �u l�Gt i 1� S'-4 t
1- . rOV ttr�i 1 �F l^ 1�A"i Ike S Q
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Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical Mechanical Plumbing
Framer Roofing Concrete Fireplace
Solar Other Other Other
Applicant: I hereby acknowledge that I hav read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort Collins inances d state laws regulating building construction.
Applicant Signature Print Name 1 1 ion gu cfA• Phone i`i7o ?81 - 13 23
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Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater I w,F6cLtll�
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE col oS%Ic -eav