HomeMy WebLinkAbout4342 WESTBROOKE CT - APPLICATIONS - 8/7/2009A
BUILDING PERMITS & INSPECTIONS DIVISION
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 0 ! / O '9' APPLICATION DATE ' -7 y(?
Job Site Address H3ML WeaV-, C—A- • Unit#
PROPERTY OWNERV1 S.INFO: (All owner information is required - it is not optional) Phone # 9'i0 - 3 i'1 ^1y X 77
Last Name 3-f t ✓1 First Name R-CC j Middle /"k I'd^c.4 1
Street Address L'l3W4 !, b ^oa Le 4 - City 4 - . o) I r•- State n Zip ra-s Zvi
CONTRACTOR INFO: Company Name 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
1st Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq Ft 'go !& Finished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/2 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: a'Gas ❑ Electric Electric Main Brea kerLSize (Residential only): ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ 5� 7
Description of Work: �a✓ �� G►, �►u wee v�+ +-� r i 5�
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical Mechanical Plumbing
Framer R fing Concrete Other
Applicant: I hereby acknnFC
a read this application and state that the above information is correct and agree to comply with all requirements
contained herein and Citydinances and state laws regulating building construction.
Applicant Signature Print Name �V4� M —�"Seh Phone Oh-b -3'7 7►1411
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE