HomeMy WebLinkAbout414 PINE ST - APPLICATIONS - 2/3/2009City of Fort Collins
BUILDING PERMTTs & INSPECTIONS DIVISION
P.O. Box 580 Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov,.com/build,ing
BUILDING PERMIT APPLICATION
APPLICATION NUMBER lJ'I OO',J O APPLICATION DATE
Job Site Address L. �v_4. �6 V -x, % (QC) Unit # 'r
PROPERTY OWNER INFO: All owner information is required it is not optional) Phone # Q 7 0 �I (2_ Snr
Last Names k) Usc v, First Name�(Qn i l k C% Middle
Street Address City �(�'l C State_Zip
CONTRACTOR INFO: Company Name �Cd-L Contractor Phone #
Lic. Holder Name City of Fort Collins License #,
Mailing Address
LEGAL INFO:
Subdivision/PUD
City.
Filing # Lot #.
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Supervisor Cert #.
State Zip
Block # Lot Sq Ft
Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1st Floor Sq Ft
2nd Floor Sq Ft
# of Bedrooms # of Full Baths
Air Conditioning: Yes No
3. ResCheck w%Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft _
% Baths. '/z Baths # of Fireplaces
Energy info: (Circle appropriate choice) 1. ComCheck
4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing
List appropriate option #s
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) $
Description of Work: U 4 I cS� •:�+)
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Mechanical
Plumbing
Framer Roofing Concrete Other
Applicant: I hereby acknowledge that f 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 t#-eo!ns ocdioaa and s ate laws regulating building construction.
Applicant Signature Print Name ey t 6 V kNVkGK Phone
istribution: White — Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE