HomeMy WebLinkAbout615 ROMA VALLEY DR - APPLICATIONS - 4/17/2013City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
� t Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
vvvvwfcgov corn/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 1 2i17 -71 APPLICATION DATE
Job Site Address A -,V-) ti Unit #
PROPERTY OWNER INFO: (All owner information is required - it is of optional) Phone # 7%d'
Last name &NT 2A/ First Name,hcaet,lc� Middle �
Street Address i7l� i lorv�ra k A /(,, A -)(1.. City t4 ' v. tl" Staatef zip O 02- S-
CONTRACTOR INFO: Company Name 62,'#6,K Contractor Phone # Y % CM /S� 2-
Lic Holder Name i .AALxk &A.YI'n..= City of Fort Collins License # 3127 - D Supervisor Cert# _
Mailing Address �%Z /(, i n , c_ %! city State Co zip
LEGAL INFO:
Subdivision/PUD i R A e-6 � E- }%A l� Filing # Lot # Block # Lot Sq
Total Building Sq Ft (not including basement) ?i499 Total Garage Sq Ft_
Residential Sq Ft Comml Sq Ft # of Stories_ Bldg Height # Dwe
1" Floor Sq Ft
2nd
Finished Bsmt Sq Ft # of Bedrooms
Air Conditioning: Ye Go Energy Info: ( Circle
3. ResCheck w/Blower Door 4. Simulated Perform
City of Fort Collins Stock Plan #
311 Floor Sq Ft Wished Bsmt Sq Ft
Baths '/. Bad 'h Baths # of Fireplaces
1. ComCheck 2. R❑esCheck w/Air Sealing
5. Prescn w/Air Sealing S. Prescriptive w/ Blower Doom
List appropriate option
Water Ta ze Sewer Tap Size Metered: Yes oNoE] Temp. Pedestal Yes o
Type of Heat: nGas ❑Electric Electric Main Breaker Size (Residential only) 0150 Amp or Less ❑ 200 Amp Other
Value of Construction (including labor, material & profit) $ .Sn('
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR: Lra kSC& Lyl dt&A CI 70 g8) oa -z-q
Subcontractor Info:
Electrical Mechanical Plumbing
Framer Yt n.- Cb�cIa.ub(- Roofing Concrete Fireplace
Solar Other Other Other
Applicant: 1 hereby acknowledge that read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of F0 Coins ggdinances and state laws regulating building construction.
Applicant SigPrint Name tAtx e -&i�e�, Phone -9?
ution: White - Office Yellow -Applicant Pink - W W W/Stormwater
S APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE