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HomeMy WebLinkAbout605 W LAKE ST - APPLICATIONS - 6/2/2009M° BUILDING PERMITS & INSPECTIONS DIVISION aaP.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 www.fcgov.com/building cityofFort Collins BUILDING PERMIT APPLICATION APPLICATION NUMBE fa g 1111 :5 APPLICATION DATE U e Job Site Address Loa W " 1 A.0 F Sal Unit # &yLf�- PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 9-70 '-ARo -ok 7'� Last NameyAI�SY('��� First Name J� A55 Middle a . Street Address L��U(o � ��' �"�� CT City :6r C�uiNS State _(1 �sa25— CONTRACTOR INFO: Company Name Contractor Phone # Lic. Holder Name City of Fort Collins License # Supervisor Cert #, Mailing Add City State Zip. LEGAL INFO: Subdivision/PUD \�LCz UI I�5 �� nlUt Sc�y Filing # Lot #_ Block # Lot Sq Ftg17q CONSTRUCTION INFO: Total Building Sq Ft (not including basement) 1 7 Cl:i Total Garage Sq Ft' © j Residential Sq Ft o�a2`� Comm'I Sq Ft— 0 # of Stories Bldg Height # Dwelling Units ` 1st Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft J�20 # of Bedrooms # of Full Baths 2 % Baths i '/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. E-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door City of Fort Collins Stock Plan # List appropriate option #s UTILITIES INFO: Water Tap Size fC1971/Vo Sewer Tap Size FXI 97'/'de- Metered: Yes or No Temp. Pedestal: Yes o No Type of Heat: ❑ Gas XElectric Electric Main Breaker Size (Residential only): ❑ 150 Amp or Less ❑ 200 Amp ❑ Other Value of Construction (including labor, material & profit) $ . ���15� . 0 0 / Description of Work: " I M i S k 07- S Ci M J7_,+-t "T rPfv D j�7 �7✓t�c�h , Contact Name & Phone # of JOBSITE SUPERVISOR: j Irk? c ir"1v5't'0b, l70 Subcontractor Info: CCL L L Q76 - 50 -13a -7 Electrical Mechanical Plumbing {pa-f L", . (,(,MIDIT Framer ! Roofing Concrete Other Applicant: I hereby ack o I d t fat I have read this application and state that the above information is correct and agree to comply with all requirements contained herein and C' o Fort ollins ordinances and state laws regulating building construction. C Applicant Signatur Print Namej F►i+��S CJW®,� a►� Phone 170 567-132 7 istribution: White - Office Yellow -Applicant Pink - WWW/Stormwater THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE