HomeMy WebLinkAbout624 SMITH ST - APPLICATIONS - 10/30/2012City
}off I I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
�` Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION - Ay
APPLICATION NUMBER_ I J l 1 (0054 APPLICATION DATE
Job Site Address Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name j-an / / �/ C.Q First Name se , 7 444&o"114, Middle
Street Address ro 2y ,,,, S//-W_f City /=t_ State C U Zip 9,6 3 2 y
CONTRACTOR INFO: Company Name / 60_4"4lA 1A? c
.01"4-_f Contractor Phone # / 72 O IS - ro � -7-�
Lic Holder Name TOM K� P City of Fort Collins License # DOE Supervisor Cart ##
Mailing Address ay'K City r- State Zip ROS 2Z
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft 00
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
161 Floor Sq Ft
Finished Bsmt Sq Ft
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
2nd Floor Sq Ft
3rd Floor Sq Ft
# of Bedrooms # of Full Baths 3/4 Baths
Unfiished Bsmt Sq Ft _
'/z 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
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit)
Description of Work: 6 U b S- U �) hQa too tr17
2/S-- G / 71'
Subcontractor Info: / �J
Electrical) CJ 1 L�IeG9rIC /M�echanicalAA ^m/�/� Plumbing ���
Framer / 7Wr►o r/e f%ichti,Roofing 'f�CaG/� A",4 k2j_ pncrete �%�/Y`/A m Fireplace
Solar—"��4T� Other rA Other 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 FF Collins ordinances and state laws regulating building construction. �/ L
Applicant Signature 22W e s Print Name T6M /C i2&/�� Phone
Distribution: White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE