HomeMy WebLinkAbout1809 S TIMBERLINE RD - APPLICATIONS - 4/2/2013City of II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort+t Collins 281 N. College Ave. - Fort Collins, CO 80522-0580 - Phone: 970-221-6760
/� www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER ® !/ APPLICATION DATE
Job Site Address I gba Sau I .ni{or(-N✓1e- 22 E6, LfSLs- Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 9 70 - ZZ(O - L4000
Last name PJV-Z 49-A tWIC/-ItNJ d 11 First Name T^ Middle
Street Address7D00 CstS� f6rC e m-ftA 2A. r1 1 JCity r- �(145 State�(� zip �oS�
CONTRACTOR INFO: Company Name 1 r rye +nnitas friu� %c»-10 Contractor Phone #
Lic Holder Name ICI City of Fort Collins License # Supervisor Cart #
Mailing Address C08� uvt.`CA C-+. Ste,1W city�State zip &DI)7
LEGAL INFO:
Subdivision/PUD Filing # Lot # 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
1S1 Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths 3/4 Baths Y: 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 �Ar Sewer Tap Size �A 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) $�? � 01, e) on
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
23T Ocp -
Plumbing
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 pf Fort Col'nsdiinances and state laws regulating building construction. /
Applicant Signature /✓� • Print Name >L� G( ��Ot lG✓j Phone 9lD`�6'' 537H
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE