HomeMy WebLinkAbout907 E LAUREL ST - APPLICATIONS - 8/15/2012of
City
Collins
APPLICATION NUMBE
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-676
www.fcgov.com/building
BUILDING PERMIT APPLICATION 5 D`
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APPLICATION
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Job Site Address 9D 7 cc, �, rz_&A.-.- F S� Unit #
PROPERTY OWNER((INFO: (All owner information is required - it is not optional) Phone #
Last name (0- to tiy First Name Dwry-e" Middle ,T .
Street Address 302 S 10 V•e 9� S� • City 4 , Col 1 H t State C_j Zip O S Z
Lic Ho` devName
Resitlentia Sq Ft _
1 loor q Ft
Finish Bsmt Sq Ft
Air onditioning:
3. ResCheck W/Blo
Company Name
Contractor Phone #
City of Fort Collins License # Supervisor Cert #.
City
State
M
Filing # Lot # Block # Lot Sq Ft
Total Building Sq Ft (not including basement) Total Garage Sq Ft
Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
2"d Floor Sq Ft
31d Floor Sq Ft
# of Bedrooms # of Full Baths
3/4 Baths
Unfiished Bsmt Sq Ft _
1/2Baths # of Fireplaces
Yes No Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
wer Door 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City wort jtollins Stock Plan #
Water lap
Sewer Tap Size
List appropriate option #s
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) $ � l.C� f �„�. -7p
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer Roofing
Solar Other
Mechanical
Concrete
Other
Plumbing
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 and City of Fort Collins ordin nces and state laws regulating building construction.
Applicant Signature /l%CQ�%� Print Name e in J Ca �_ �ro :r, Phone C� q -- 3 6 2 5—
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE