HomeMy WebLinkAbout437 N ROOSEVELT AVE - APPLICATIONS - 12/17/2012COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fegov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER ) �/ JknO APPLICATION DATE
Job Site Address q 3 % Ayr,-- �U%niit-7#
PROPERTY OWNER (All o information is required -it is not optional) Phone #
Last name J e.::S:RS First Name Middle
Street Address V 3 7 7 �Y�GT A--&-- City 1' �� cState �®?ZZiip
CONTRACTOR INFO: Company Na -Fe— r.T7VAJ5 Contractor Phone # C ;O Z.,®39 Cam/
Lic Holder Name City of Fort Collins License # 4 (r7� Supervisor Cart # C
Mailing Address /V City State Zip eoCJy
LEGAL INFO:
Subdivision/P
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq
1s' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
# of Stories Bldg Height # Dwelling Units
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths 3/, 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 ❑ 200 Amp []Other
Value of Construction (including labor, material & profit) $ loci t)
Description of Work: fN �� L L- 2,p�c35 AADC x"
Contact Name & Phone # of JOBSITE SUPERVISOR: Zt
Subcontractor Info:
Electrical Mechanical Plumbing
Framer Roofing Concrete Fireplace
Solar Other Other
Applicant: I hereby, acknowl ave read t s application and state that the above information is correct and agree to comply with all requirements
contained herein an of Fo Ili ordinanc and state laws regulating building construction.
Applicant Signature rint Name Lr �s"ikone �9'
i ution: White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE