HomeMy WebLinkAbout823 HILLDALE DR - APPLICATIONS - 1/23/2013COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
City of
Fort Collins
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
www.fcgov.com/building -0 1up "1 C'
BUILDING PERMIT APPLICATION
APPLICATION NUMBER Ly`34 1 APPLICATION DATE I - '�15 'l ✓
Job Site Address Y Z3 ffi LLT >!�!E /Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #%� 82 10
Last name ? First Name i PAZ) Jowl' Middle
Street Address 2 2J LLD6CL`� '_ �r_,��� •�T. � A,, �City__CDLI-1 —State 60 zip 8 G Z
CONTRACTOR INFO: Company Name i_,rI L3 t( ty t'l �C Contractor Phone #'9 %O -% ZC� - j C,,% 7
L.ItAPCAV•e :K !f Vf? t Y►oN
Lic Holder Name 111doll4l NRC-a E::1 City of Fort Collins License # 2" 7-6p Supervisor Cert # 3 O " 2.
Mailing Address_CG E: x 2 -7 1 2 / 3 City FT 6a_wq:�) State C-0 zip 8O 7
LEGAL INFO: GLP( e voa
Subdivision/PUD�� Z �l u'ILLz7 Filing # ST Lot #LL � Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
151 Floor Sq Ft
2ntl Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths /2 Baths # of Fireplaces
Air Conditioning: Ye�]Nou 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 []NoF-1 Temp. Pedestal Yes❑ No ❑
Type of Heat: ❑ Gas1-1 Electric Electric Main Breaker Size (Residential only) 1:1150 Amp or Less ❑ 200 Amp DOther
Value of Construction (including labor, material & profit) $ 3i� �0 per-'r,
Description of Work: i>E�c_K mlr,>
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
�ramer Roofing
Solar
Other
Mechanical
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowl dge that I have read th' application and state that the above information is correct and agree to comply with all requirements
contained herein and Cit of 'rt C s ordi antes nd state laws regulating building construction.
Applicant Signature Print Name I- A TD r-_ -�'x'>F Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
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