HomeMy WebLinkAbout6802 NIMITZ DR - APPLICATIONS - 1/22/2013City of 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
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APPLICATION NUMBER 7ZOAPPLICATION DATE 1—'2 �
Job Site Address (W Z KhVM 1 T--Z910LA Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name -%1liL First Name V 1215 Middle
Street Address 6'&02 01M (T Z P-�-104 City T 0V&-'V C�9w QS LSjt'atte CAD Zip
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CONTRACTOR INFO: Company Name �i t� ��� 6k01�V5 Contractor Phone # 1 10-a ari (OT t
Lic Holder Name '` 1 zz oz- City of Fort Collins License # Supervisor Cert #
Mailing Address y3\q Wl'Ui7 LA W'(- 9-Al nn• City Vj�NDS'Dyz- State 6V Zip S-05)1
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
__ Residential Sq Ft Comm'I Sq
151 Floor Sq Ft
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
2nd Floor Sq Ft 31 Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft �17 # of Bedrooms 2 # of Full Baths .,4b� 3/< Baths I '/z B6 aths -- # 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 #s
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) $ A, DIM -A%
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR: �z' TYL'ky WYL-
Subcontractor ,I nfo::
Electrical t'
I L, "' ItT Plumbing W"J
C i;E00NAA
Framer.Roofing
Solar Other
Mechanical
Concrete
Other
Fireplace
Other
Applicant: I hereby acknow�ed t I have r e this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort C `ins rdi a es and state laws regulating building construction.
Applicant Signature I Print Name R-WY"OK- Phone 2'11"1
Di tion: White - Office Yellow- Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE