HomeMy WebLinkAbout825 E LAUREL ST - APPLICATIONS - 6/7/2013City of II 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 APP'LpICA% TION
APPLICATION NUMBER 0 h� a � APPLICATION DATE �Y
Job Site Address
MU'Unit #
PROPERTY OWNER INFO:
FO: (All owner information is required-,,itti�is--not optional) Phone # q76 �i� 9 %o
Last name_ CN First Name�LU4- Middle
Street Address aa3�-F1 j5wy/i� b1z City lotleA ,VD Statej�fe)_Zip
CONTRACTOR INFO: Company Name Contractor Phone #
Lie Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft
151 Floor Sq Ft
Finished Bsmt Sq Ft
Comm'I Sq
2n1 Floor Sq Ft
City State Zip
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths '/, 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
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only)
Value of Construction (including labor, material & profit.) p �/
Description of Work: fyrin
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Temp. Pedestal Yes or No
150 Amp or Less ❑ 200 Amp ❑ Other
3 , go
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 of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature Print Name Phone
Distribution: White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE