HomeMy WebLinkAbout903 BUCKINGHAM ST - APPLICATIONS - 10/6/2008BUILDING PERMITS & INSPECTIONS DIVISION
PO Box 580 • Fort Collins, CO 80522-0580 • Phone 221-6760
66 www fcgov com/buildmg
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER CJ 91W APPLICATION DATE
Job Site Address cla RWbCIN(>, Aw ST Unit #
PROPERTY OWNER INFO (All owner Information is required - it is not optional)
Last Name LA 1 �3l li^V ,,)'__�,,-,,G,, ,First
Street Address_' MOO C. N*,A `N 5t'-
Middle (/ `�/
State r_ZIP 'b0J L
i CONTRACTOR INFO Company Name t a � Contractor Phone # N/A
Lie Holder Name A NIA- City of Fort Collins License # NIA Supervisor Cert # VIA
Mailing Address t 1A City N/A State M1 Zip
LEGALINFO I' (1 1 �y
Subdivision/PUD g0�,AW"IKS Sub. Filing # 2J Lov 1/2/ Block # — Lot Sq Ft �r� �oio 7,&
CONSTRUCTION INFO Total Building Sq Ft (not including basement) S�xl*/ J / OCK5 Total Garage Sq Ft
c15+6A
Residential Sq Ft Comm I Sq Ft 30fooGJa # of Stories Bldg Height # Dwelling Units
1st Floor Sq Ft
# of Bedrooms '
Air Conditioning Yes No
3 ResCheck w/Blower Door
City of Fort Collins Stock Plan #
2M Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Full Baths '% Baths — Y Baths # of Fireplaces
Energy info (Circle appropriate choice) 1 ComCheck 2 ResCheck w/Air Sealing
4 E-Star w/Blower Door 5 Prescriptive w/Air Sealing 6 Prescriptive w/Blower Door
UTILITIES INFO IW pfb f .c . _1
Water Tap Size Sewer Tap
List appropriate option #s_
tb it I, [)-he 5
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) $ DescnionofWorkCAN(mE USE 011F- DJ1LD`4V1 ;m,"om1C2 A4 tKAK� yD1t
Electrical
Framer
Roofing
Mechanical
Concrete
Plumbing
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 Signature Print Name
Di tr ubon White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE