HomeMy WebLinkAbout912 CHEYENNE DR - APPLICATIONS - 5/20/2005City of Fort Collins
APPLICATION NUMBE
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov com/building
BUILDING PERMIT APPLICATIO
APPLICATION
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Job Site Address I d2 C- Iv e Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 9 7 .2-2
Last Name a v V'V v ' First Name r.J 0 ex I Middle 1 �-e ✓`
Street Address / G� �/� �� G-�G I-d'� L..r�••eCity Cj /I ,-r State.Q Zip
CONTRACTOR INFO: Company Name Contractor Phone #
Lic. Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address City State Zip
LEGAL INFO: / I p�
Subdivision/PUD�v JJ _ _ so, #A Filing Lot #,ap Block # Lot Sq Ft /197
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) / . J aZ Total Garage Sq Ft 6
Residential Sq FtA 04 0 Comm'I Sq Ft IVA # of Stories % Bldg Height # Dwelling Units
15t Floor Sq Ft 510 2nd Floor Sq Ft 1 Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Bedrooms 5 # of Full Baths I % Baths 1 Y2 Baths I # of Fireplaces _
Air Conditioning: Yes No Energy info: (Circle appropriate choice) 1. ComCheck
3. ResCheck w/Blower Door 4. E-Star w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
It
A%
2. ResCheck w/Air Sealing
5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
List appropriate option #s
Water Tap Size fly Sewer Tap Size 1 Metered- Yes r No Temp. Pedestal: Yes or ONDO
Type of Heat: )I Gas ❑ Electric Electric Main Breaker Size (Residential only): or 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor „fn terial & profit) $A�C� S I I'le - L
Description of Work: •�+s �, q ✓'PSS (iv �► v cv r 6 q X 1 g � � r� Y� v TIC ato.-
W!11
e & Phone # of JOBSITE S
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Subcontractor Info:
Electrical C h a 4 W(,k
,p� Mechanical) /� /1/ i7 Plumbing p 1�
Framer Reike,I- ti�ton �! RoofiA /V /7 Concrete 1y 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 CitA�,
rt Collins ordinances and state laws regulating building construction.
Applicant Signature �..�— Print Name ()Or1 V6,1, #% :33-1 Phone �0 :2 1
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE