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HomeMy WebLinkAbout638 EBON PICA ST - APPLICATIONS - 6/1/2009BUILDING PERMITS & INSPECTIONS DIVISION Q4 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 / APPLICATION DATE �' I'© / Job Site Address Unit # PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone # Last Name /�l'rt►1al',le,-�IM, L--ya First Name Middle Street Address Az City (/°l�i��' Statezip/yd'O� I CONTRACTOR INFO: Company Name /711d'71_/41✓ 4�2 Contractor Phone #'/9-Os—ok Lic. Holder Name e,4<s 1/(x City of Fort Collins License # 4;2 &q Supervisor Cert #el7.­ Mailing Address GL City State C.6 zip d'OQ /0 LEGAL INFO: Subdivision/PUDFiling # Lot # Block # Lot Sq Ft 10-26 CONSTRUCTION INFO: Total Building Sq Ft (not including basement) ! IbRe Total Garage Sq Ft 700 Residential Sq Ft 116Comm'I Sq Ft # of Stories v2 Bldg Height # Dwelling Units 1st Floor Sq Ft S'760 2nd Floor Sq Ft '5VO Unfinished Bsmt Sq Ft S?6 Finished Bsmt Sq Ft d # of Bedrooms Air Conditioning: Yes No ResCheck w/Blower Door City of Fort Collins Stock Plan # # of Full Baths % Baths '/2 Baths # of Fireplaces D 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 r-74 3 List appropriate option UTILITIES INFO: n Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal: Yes or No Type of Heat: XGas ❑ Electric Electric Main Breaker Size (Residential only): *150 Amp or Less ❑ 200 Amp ❑ Other Value of Construction (including labor, material & profit) Description of Work: /(/A./ grl4e"6'_y i Contact Name & Phone # of JOBSITE SUPERVISOR: P4.i4S We& G/'isvs--or Subcontractor Info: / /% Electrical % /Or'1 � Mechanical /CO to 7� Plumbing & Framer j B. Roofing �r� Concrete I k IBNCi A 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 Collin or 'nances and state laws regulating building consstt�ructi�onn.% �� Applicant Signature Print Name el w�Alf Phone Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater THIS APPLICATION (EXPIRES 90 DAYS FROM APPLICATION DATE