HomeMy WebLinkAbout942 DRIFTWOOD DR - APPLICATIONS - 11/15/2012City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rt Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATIONC/7
APPLICATION NUMBER rJ /o `V YG (I APPLICATION DATE
,Jab Site Address ���(Zt FTesr;�Q r �E Unit #
PROPERTY OWNER INFO- (All o inform n is required - it is not optional) Phone #
iLast name t4 t�T)t � First Name da_Me1I Middle
Street Address
City
State Zip
CONTRACTOR INFO: Company Name�A "l�.� Q i F� Contractor Phone # '7 -32a - 52,80
Lic Holder Name It/ Q�'�►�� / AO&- s'S� City of Fort Collins License # Supervisor Certt #
Mailing Address ���I VJ r� q—AL City 6.1�1/-.uJ?la(� State�Zip 9io%27
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft
151 Floor Sq Ft
Finished Bsmt Sq Ft
Comm'I Sq
2nd Floor Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
31 Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/2 Baths # of Fireplaces
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 #
UTILITIES INFO:
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 ❑ 20O Amp ❑ Other
Value of Construction (including labor, material & profit) $
Description of Work, -- '3Qzw- p-e tEN gCc`5dz--
k1tY�f 7cr.�i 5.A_S�E`ZcO� il% $2E�4t��
Name & Phone # of JOBSITE SGPERVISOR:
Subcontractor Info
Electrical
Framer
Solar
Applicant: I hereby acknc
contained herein and City
A cant Signatur
Roofing
Concrete
Other
2, t rrlo•vt jolLe.rJC
boa /J�� .. � /irui•
Plumbing
Fireplace
Other
application and state that the above information is correct and agree to comply with all requirements
id state laws regulating building constr tion.
Print Name R . L4--msaPhone �Zo 320.34b
White —Office Yellow —Applicant Pink — WWW/Stormwater
THOS APPLOCATOON EXPURES 180 DAYS FROM APPLOCAVOON DATE