HomeMy WebLinkAbout617 W MYRTLE ST - APPLICATIONS - 6/2/2005BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
City of FortCollins BUILDING PERMIT APPLICATION
LAPPLICATION NUMBER CJ1'S V o & APPLICATION DATE 6 — �6s— I
Job Site Address & i+-q- W RM-ri-C S7_0-C&7— Unit #
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone # 4 $L4 ^ S'$b
Last Name 01d11 / First Name__ �< C_ ZfA!S.b%,, Middle llot—a.a. m -
Street Address G f-- W ±M.y ,r+Vt.- St- CityF`T' f_g-_Ls. jP-A_% State G'A ZipL'9O 7I
CONTRACTOR INFO: Company Name 0 l Pt Contractor Phone #
Lic. Holder Name City of Fort Collins License #
Mailing Address,
City
State
Supervisor Cert #
LEGAL INFO:
Subdivision/PUD i ZS wF s-r L.A A N Filing # W LAIA13 Lot #_41_ 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
1st Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/ 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 #
UTILITIES INFO:
Water Tap Size Sewer Tap Size
List appropriate option #s,
Metered: Yes or No Temp. Pedestal: Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only): ❑ 1500 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ ! 0.
Description of Work: �AcSP.MRtr PoJILSr
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical Mechanical
Plumbing
Framer Roofing Concrete 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 � lkPrint Name �, -- 0 `Q ` Phone 14 8y '�6 6
Distribution: White — Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE