HomeMy WebLinkAbout6802 NIMITZ DR - APPLICATIONS - 1/16/2014COMMUNITY 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 l� �7 0 �? OZ APPLICATION DATE I l 6// /
Job Site Address 64' 02- A/(Jilt tj—D�e— . FM erOs-lb Unit #
01-7c\—ZQ,?—Lia-IQ
9 10Z
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone #
Last name W i r T i (,- First Name d AA ( C/87A-tL Middle
Street Address d �' N I W I � /' 1-- City Ft CZ L" NS State C-111 Zip eia
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft
15' Floor Sq Ft
Corri Sq
2nd Floor Sq Ft
Contractor Phone #
City of Fort Collins License # Supervisor Cart #_
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
Finished Bsmt Sq Ft Z 0 # of Bedrooms # of Full Baths 3/ Baths '/2 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 labor,
material & profit) $1 — (0 Z 6 ' qD
Description of Work: LNG 1 ^�9 �/1-*4'LW Gi E'sk P-rrL 5-h-t— Atli )0rt%'i L J A- Lt-
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical Mechanical
Framer Roofing
Solar Other
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 FoltCollin or ces and state laws regulating building construction. ,
J /Lt I r_*t;fLL. ul i 7 r� (r 3a -d 102.1
Applicant Signature ( � Print Name Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE