HomeMy WebLinkAbout809 SMITH ST - APPLICATIONS - 8/27/2013City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
FOI t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
/ www.fcgov.com/buiiding
BUILDING PERMIT APPLICATION
APPLICATION NUMBER V 1 E5y 45S APPLICATION DATE -- �� ✓�
Job Site Address (�C) 7 ,l)n, ,,fig (� Unit #
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone #
Last name l_ 0pSS
i. S
First Name —or) / / C� . Middle
Street Address
/ �190 F J_1er
o/''}` ! n+%2_ City, e_
c
State��Zip O-s a
CONTRACTOR IN
O: Company Name.
Contractor Phone #
Lic Holder Name
a r City of Fort Collins License #
Supervisor Cert #
Mailing Address
D s
//
n L CitState
6Zip O 7Q
LEGAL INFO:
Subdivision/PU
Filing # Lot # Block # Lot Sq Ft_
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'[ Sq Ft # of Stories Bldg Height # Dwelling Units
1$1 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 Yz 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 #s
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
Description of Work:
material & profit) $ c), 0
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
O C� r/4
_ 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 Cit of ort Collins�—M�
state laws.r gulating building on ru tion. /
Applicant Signature /)Print Name C. / /, L V s •! Phone �7 �C7 Q-/ 0 /
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPURES 180 DAYS FROM APPLICATIODd DATE