HomeMy WebLinkAbout612 PROUTY CT - APPLICATIONS - 2/9/2009g
BUILDING PERMITS & INSPECTIONS DIVISION
P.6O.Box580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 0ki�l
www.fcgov.conVbuilding
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER lJ— l V�/� l( APPLICATION DATE
Job Site Address - Z1,2
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone #
Last Name r'2u , First Name J Middle L;
Street Address ��/E� Prc✓ ��. City,j T %7- ,, �r State G Zip J
CONTRACTOR INFO: Company Name Contractor Phone #
Lic. Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address,
LEGAL INFO:
Subdivision/PUD
City
Filing # Lot #
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft
1st Floor Sq Ft
# of Bedrooms
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Unit #
State Zip
Block # Lot Sq
Total Garage Sq Ft
Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft _
# of Full Baths 3/< Baths '/2 Baths
Energy info: (Circle appropriate choice) 1. ComCheck
4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing
List appropriate option #s
# of Fireplaces
2. ResCheck w/Air Sealing
6. Prescriptive w/Blower Door
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) $ p,0>Le l . 43 aF�I � (! �_��clC-� t a tDD i . cot-
Description of Work: Pa� �t l (L t kaQj Y11_U-d t'1 lSh / T�I — 1 Y l �Ll ( 1 15 :,:? o dg S1 T I
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Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Mechanical
Plumbing
Framer Roofing Concrete 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 Signatur —0�0111Print Name �Gi'�j C��f2�//_ Phone
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE