HomeMy WebLinkAbout6802 NIMITZ DR - APPLICATIONS - 5/17/2013City of
I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
�t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER F I -_3D oC J0 f4 APPLICATION DATE J I T
Job Site Address 6 2- 049111 P' ' GAD I Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 110-2I1'lq-7 4
Last name (/e1/1rr(__ ,n 'nA First
/Name L"MIL_ Middle ,ice
Street Address W 0 V �i (� r yl A- -L L^ 610 1 Qa� City, .^,R CO I I � S • State w1/� �zii`p� � l
CONTRACTOR INFO: Company Name EX'tG�t7Ave. 6(k Contractor Phone # "110-2,M- 1`1-1'1
Lic Holder Name / . T�o�1 �,N- City of Fort Collins Liic/ense # Supervisor Certt #
Mailing Address_ City VvASO`f State Zip
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
1s' Floor Sq Ft 2nd Floor Sq Ft 3'd Floor Sq Ft Unfiished Bsmt Sq Ft _ _
Finished Bsmt Sq Ft (P # of Bedrooms # of Full Baths 3/4 Baths '/z 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 # List appropriate option #s
UTILITIES INFO:
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) ,$ IIQ �EiSI/ •lj(p
Description of Work:_ �I�IUSI/l � �oowl 1 C. � ii llwV� a4 sA% vAwtk .
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical UL#_& li/1n. Mechanical Plumbing YVI*Q*,AAA�
Framer E"(>° f- A Roofing Concrete Fireplace
Solar Other Other Other
Applicant: I hereby acknowled haver ad this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of F ollin or ' nces and state laws regulating building construction.
Applicant Signature Print Name t"-��/I�UI� Phone
D' trib tion: White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE