HomeMy WebLinkAbout424 PINE ST - APPLICATIONS - 5/14/2009BUILDING PERMITS & INSPECTIONS DIVISION
�y P0. Box 580 • Fort Collins, CO 80527,0580 • Phone: 221-6760
� �) www.fcgov.com/building
(100�
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER
�D �APPLICATION DATE
Job Site Address qZy /Nfi f-tw-r , # I Div Unit # 100
PROPERTY `O/WNER INFO: (All owner information is required — it is not optional) Phone #
Last Name �IAN First Name / Middle DIM
Street Address y sT i%� City 7 C. 1• WIiLIAiS State GD Zip 07m
CONTRACTOR INFO: Company Name 'I9D Contractor Phone #
Lic. Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address
City
State Zip
LEGAL INFO:
Subdivision/PUD
Filing # Lot #
Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft
# of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft 2nd Floor Sq Ft
Unfinished Bsmt Sq Ft
Finished Bsmt Sq Ft
# of Bedrooms # of Full Baths
% Baths Y2 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 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) $
5 UGD
Description of Work:
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WJ4 /1 40i- lCA*AlE.
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Contact Name & Phone # of JOBSITE SUPERVISOR: P-+JJD w4tJ Y h"64-
Subcontractor Info:
Electrical Mechanical 14A• Plumbing Ng
Framer N/} Roofing Concrete lVi9 Other
Applicant: I hereby acknowledge that 1 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 Col' s inan s and state laws regulating building construction. f
01
Applicant Signature ,-- — Print Name pfi"✓1D �4N Dl1M - Phone
Distribution: White — Office Yellow —Applicant Pink — VWVW/Stormwater 7 03
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE