HomeMy WebLinkAbout4112 MOUNT VERNON CT - APPLICATIONS - 11/19/2012City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.conn/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER1 /—U'`11 APPLICATION DATE_
Job Site Address '+1 ( Z tA+ Vey- non C+ • Unit #
PROPERTY OWNER INFO: (All owner information is required - it Is not optional) Phone #
Last name G Uj L- / A_) First Name S A-T-d (i( Middle
Street Address -6a- '1 e- City State Zip
CONTRACTOR INFO: Company Name
Lic Hol Name City of Fort Collins License #.
Mailing ddress City
Subd
Filing # Lot #
Total Building Sq Ft (not including
Contractor Phone #
Supervisor Cert #.
State
Block # Lot Sq
Total Garage Sq Ft
Sq Ft Comm] Sq Ft # of Stories Bldg Height # Dwelling Units
151 Floor Sq Ft
Finished Bsmt Sq Ft
Arr ditioning: Yes No
3. Re ck w/Blower Door
City of Fort Collins Stock Plan #
20d Floor Sq Ft
31d Floor Sq Ft
# of Bedrooms # of Full Baths Y4 Baths
Unfiished Bsmt Sq Ft _
% Baths # of Fireplaces
Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
List appropriate option
UTILITIES INFO:
Water Size Sewer Tap Size Metered: Yes or No Temp. Pedestal Yes or No
Type f Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ krJ 6 0
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical 5 Gl t Mechanical
Framer Qat,vrQ,t (V) 01 6-4&fing
Solar
Other
Concrete
Other
Plumbing 14-g i4 ►-
Fireplace
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 an elti ces and state laws regulating building construction.
7
Applicant Signature Print Name S hJ'ij Ncuj [Vif)Phone'170 -q $8 -a 168
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE