HomeMy WebLinkAbout615 W LAKE ST - APPLICATIONS - 3/13/2009BUILDING PERMITS & INSPECTIONS DIVISION �(
i P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER &Q 01'? —� APPLICATION DATE v ,13,0 q
YJob Site Address (A W La`Cc'lif • Unit #
cPROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # (a—oan
Last Name First Name lea (-\ Middle
Street Address o�� W O City �e `As- F—e- State\ ' t' l Zip
CONTRACTOR INFO: Company Name
Lic. Holder Name
Contractor Phone #
City of Fort Collins License #
Mailing Address City
LEGAL INFO:
7� Subdivision/PUD
Filing # Lot #,
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft
15t Floor Sq Ft
# of Bedrooms
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Supervisor Cert #.
State Zip
Block # Lot Sq Ft
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 1/4 Baths '/2 Baths
Energy info: (Circle appropriate choice) 1. ComCheck
4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing
List appropriate option
# 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) $
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR: r 1 O
Subcontractor Info: 9?3 30�
Electrical Mechanical Plumbing
Framer Roofing Concrete Other
Applicant: I hereby acknowledge that I have is application and state that the above information is correct and agree to comply with all requirements
contained herein and Collin a. es d state laws regulating buildin construc' c� /
G I 1 0� o2tot
Applicant Signature Print Name v f, V Phoneg70 �67
istribution: White — Office Yellow — Applicant ink — W W/Stormwater
T S APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE