HomeMy WebLinkAbout417 N ROOSEVELT AVE - APPLICATIONS - 7/2/2009BUILDING PERMITS &INSPECTIONS DIVISION 43013
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBERAPPLICATION DATE q, a Oq
-*Job Site Address `% /�, �/�Lfi � V & Unit #
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone #
Last Name Yr/96l 4e First Name d �'L Middle ,G
Street Address ��� �r ��Se��t City 1470Y4�0 State ZipJy
giCONTRACTOR INFO: Company Name D�/I/�7" Contractor Phone #
Lic. Holder Name,
Mailing Address_
LEGAL INFO:
Subdivisl UD
CONSTRUCTION
Residential Sq Ft
1st Floor Sq Ft
# of Bedrooms
City of Fort Collins License #
City,
Filing # Lot #
Total Building Sq Ft (not including basement)
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stockmen #
'I Sq Ft # of Stories,
Supervisor Cert #
State Zip
Block # L'St Si
,.Total") Garage Sq Ft
Ft
g Height # Dwelling Units
2nd Floor Sg`Pt`_ Unfbis4e—d Bsmt Sq Ft Finished Bsmt Sq Ft
# of Full Baths Batkts '/z Baths # of Fireplaces
:nergy�inro. (Circle appropriate choice) 1. ComCreok 2. ResCheck w/Air Sealing
--Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescript) eaw/Blower Door
List appropriate option #s
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) $/6D
►Description of Work:yCLOse/�5//yam/
Contact Name & Phone # of JOBSITE SUPERVISOR:
.Subcontractor Info: / !
Electrical ��� jr/���� Mechanical e 141g1/ / mbing
Framer �� Roofing SC� Concrete �t 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: "orA4� Print Name Phone
Distribution: Whi e — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE