HomeMy WebLinkAbout615 S LOOMIS AVE - APPLICATIONS - 2/19/2013City
}of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
�` Collinsll281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970.221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER —N?b O�IJ \ APPLICATION DATE C / t !,/
Job Site Address 6 / 5 S 2-o D 0-11 f S Unit #
PROPERTY OANER INFO: (All owner information is required - it/is not optional) Phone # / Zy— / 9 P —77� Z-
Last name N First Name (fa e r --Aj Middle
7
Street Address 2 7 ��Cx.r ,t4 City �—n lUjA L State__<_(,)Zip
CONTRACTOR INFO: Company Name (� ,.eti "i ' Contractor Phone # g }-o -Z � 'j �} o
Lic Holder NameAN \'7�-0'(t� City of Fort Collins License #�(,' Supervisor Cert #_�_
Mailing Address 169'Z.r1 — /t( cc/� i i'��'�' City ��_ State C CD
LEGAL INFO:
Subdivision/PU
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft
1" Floor Sq Ft
Finished Bsmt Sq Ft
Comm'I Sq
2nd Floor Sq Ft
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3" Floor Sq Ft
Unfiished Bsmt Sq Ft
# 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/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) $ /2� 0
of
L. )
Contact Name & Phone # of JOBSITE SUPERVISOR: T��r �'N 1 r✓ 3 / V
Subcontractor Info:
Electrical
Framer
Roofing
Mechanical
Concrete
Plumbing
Fireplace
Solar Cher Other Other
Applicant: I hereby acknowle have read thi application and state that the above information is correct and agree to comply with all requirements
contained herein and i yof Fort Collins dinances and state laws regulating building construction.
Applicant Signature ==2E=2 Print Name Phone 2r,r3` 3s?o
Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE