HomeMy WebLinkAbout919 W MOUNTAIN AVE - APPLICATIONS - 10/1/2010City
Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER o O ss� `) APPLICATION DATE Is—ko
Job Site Address W `7 W , 1Koum r-}P lm A& Unit #
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone # 7 gq' _-3 g q
Last name GU 6- S 4) ( n(' First Name dA R L. Middle
Street Address /[����(5 9_D da`�!'� (� n,/,aiOcity ,�f!li&-e State �6 Zip 65111.
CONTRACTOR INFO: Company Name �0C-S �- p06ei T:fE HjK Contractor Phone # cj70 -- 7
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Lic Holder Name 4f L, [ F FUPZ (> H 4J:2r City of Fort Collins License # C -;21 3 Supervisor Cert # 707 7 - C
Mailing Address c1q (20 a P PA C p City 1=7. C0 LL! e C3 State dQ Zip j Z
LEGAL INFO:
Subdivision/PUD
Filing # Lot #
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft Comm] Sq Ft # of Stories
1s' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3rd Floor Sq Ft
Block # Lot Sq Ft
Total Garage Sq Ft
Bldg Height # Dwelling Units
# of Bedrooms # of Full Baths 3/4 Baths
Unfiished Bsmt Sq Ft
'/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
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) $
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Description of Work: i? E Fatoc i' d t iFLi C� (�( Pf± Tt C� h( G gyp► LC _
r? 6 RAt R 2
Contact Name & Phone # of JOBSITE SUPERVISOR: Oc ci=T elI rZ D $4 kT
Subcontractor Info:
Electrical /�} Mechanical/ Plumbing/Q
Framer C, [-� t /� A Y-2 7- Roofing ''�� Concrete 5 (�% CQc�IC(C, Fireplace
Solar (1i %� Other WfI Other 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 1 ws regulating building construction.
Applicant Signature Print Name &—I t=0 f2P 1-(. t-[ei /-{TPhone g t 7--Z73 3
/ tl , — --r==P :g(- Z��&
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE