HomeMy WebLinkAbout612 E PITKIN ST - APPLICATIONS - 8/17/2013COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. - Fort Collins, CO 80522-0580 - Phone: 970.221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER I APPLICATION DATE S 0 /
Job Site Address ivt'-z 6 �c� S-r #cozy- ln.0 i Nl Unit # `
PROPERTY OWNER
' INFO: (All owner information is required - it is not optional) Phone #
Last name Nln eS First Name( l Cff461( Middle /V
Street Address (.l `Z g i kf^ ST City W //y; State l p Zip Co f2
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
Contractor Phone #
City of Fort Collins License #
Citv
Filing # Lot #.
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft 3 0 �-/ Comm'I Sq Ft # of Stories
1s' Floor Sq Ft
2nd Floor Sq Ft
31 Floor Sq Ft
Supervisor Cert #
State Zip
Block # Lot Sq Ft
- Total Garage Sq Ft
Bldg Height # Dwelling Units
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths '/2 Baths # of Fireplaces
Air Conditioning: Yes CO) 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 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) $ s ! V
Description of Work:�j�,Gltsslil/ _ cSGiNic. /V rtV-6d;4'1 O
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
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 F n Collin ordinances and state laws regulating building construction.
Applicant Signature Print Name !M % Lf//16� Ny✓19N� Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATOON EXPORIES 180 DAYS FROM APPO-OCATOODd DATE