HomeMy WebLinkAbout421 SAN JUAN DR - APPLICATIONS - 1/3/2013Cityof
I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort+ ` Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221.6760
/ www.fcgov.com/building
BUILDING PERMIT APPLICATION T7.
APPLICATION NUMBER Q W 3t� r
APPLICATION DATE L � ✓ ^ 1 /3
Job Site Address
_9�Z I �G�, tAk r
Unit #
PROPERTY OWNER INFO: (All owner information Is required - it is not optional) Phone # ! ZS 33 0 5 � py
Last
First Name Middle
Street Address 1 City State Zip
CONTRACTOR INFO: Company Name � V 12 t�I-F L4 /^h ��n_l Contractor Phone # 4t�0 720 S 96
Lic Holder Name (:A Vyf" Y>1 L 11CVkd City of Fort Collins License # Supervisor Cert #
Mailing Add
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft 986 Comm9 Sq Ft
City
State Zip
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
151 Floor Sq Ft 2nd Floor Sq Ft 3`d Floor Sq Ft Unfiished Bsmt Sq Ft / �-f kio
Finished Bsmt Sq Ft —Ali# of Bedrooms # of Full Baths % Baths % 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/Aiir Sealing 6. Prescriptive w/ Blower Door
I City of Fort Collins Stock Plan # ( 0 9 List appropriate option #s ("� r 3
UTILITIES INFO:
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:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical! �Q
Framer if 10SY FO i d te-y( Roofing
Solar
Other
Mechanical LL Plumbing :::r4 C-
Concrete
Other
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 ordinances and state laws regulating building construction. l j b C y,
Applicant Signature �� Print Namesco� L!/ Phone �� 0 S3 / 3 /Q V
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE