HomeMy WebLinkAbout938 W MOUNTAIN AVE - APPLICATIONS - 4/7/2005BUILDING PERMITS & INSPECTIONS DIVISION
} ss. 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 5O �✓� 1 i 1 APPLICATION DATE 4-� 0`5
Job Site Address al , /Vob?f ,,, A� Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # ` it70 0 73
Last Name HA-6,420 First Name 77-0-011CC Middle
Street Address l 3Y 6�1 X4 c, /n>kf City f �r� l� `� 5 State 6� Zip
CONTRACTOR INFO: Company Name 4-1-6/7' Contractor Phone #
Lic. Holder Name City of Fort Collins License # Supervisor Cert #,
Mailing Address,
LEGAL INFO:
Subdivision/PUD
City,
Filing # Lot #.
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft +;WC0 Comm'I Sq Ft # of Stories o�
3
State Zip
Block # Lot Sq Ft -t k3 -7
Total Garage Sq Ft (n c
Bldg Height # Dwelling Units
I Floor Sq Ft O 2nd Floor Sq Ft t2--AU Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Bedrooms # of Full Baths 'r"3 -/< Baths '/2 Baths # of Fireplaces
Air Conditioning: Ye No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing !�
3. ResCheck w/Blower Door 4. E-Star w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Water Tap Size Sewer Tap Size
5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
List appropriate option #s
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) $ HOC'% dUo
Description of Work: Ke✓No.iC ,�Q�J/j C� q ,O`�1 rT7" qr/ �,� Ll
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Mechanical
Plumbing
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 Collins ordinances and state laws regulating building construction.
Applicant Signature ��Ditribution.
Print Name Va'g kG #4-Y cr r'ff Phonee %/ White —Office Yellow —Applicant Pink — WWW/Stormwater
•% THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE
Roofing
Concrete