HomeMy WebLinkAbout621 WOOD ST - APPLICATIONS - 10/19/2012COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
APPLICATION
Job Site Add
281 N. College Ave. • Fort Collins, CO 80522.0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION DATE IU_1�rR_
Unit #
PROPERTY OWNER INFO: (All owner information is required — it is not optional) PhoneGS!�r]'
Last name First Name :¢/AL.1 Middle L.
Street Address t2.1 Wes/ !t2 , City � �L� //.�J State 6b Zip d'J_aj
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Add
LEGAL INFO:
Contractor Phone #
City of Fort Collins License #
City
Supervisor Cart #
State Zip
Subdivision/PUD ( ANY' 1Tt>-- L—h L_ Filing # Lot 4_10— Block # r�ot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm9 Sq Ft # of Stories Bldg Height # Dwelling Units
1 s' Floor Sq Ft
Finished Bsmt Sq Ft
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
20d Floor Sq Ft
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths 3/< Baths '/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) $ 22 1 3�0
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: n 11
Electrical Mechanical '� Plumbing
Framer_Roofing I Concrete Fireplace
Solar NI� Other Other Other
Applicant: I hereby acknowledge that I have r ad this application and state that the above information is correct and agree to comply with all requirements
contained herein and ty C Cins ordi antes to laws regulating building construction. �L,�,
Applicant Signature Name Phone MA-9
Distribution: White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE