HomeMy WebLinkAbout437 DERRY DR - APPLICATIONS - 9/29/2009BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.conVbuilding
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBERt� & 4 RO9ZZ� APPLICATION DATE 17—cw—d7
Job Site Address �Unit #
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone #SrS—
Last Name —0GZy t .S First Name wlf Middle
Street Address y� P i r y �� City �f �o,/�,i7 State- 69 ZipOS2 S
CONTRACTOR INFO: Company Name
Lic. Holder Name
Mailing Address
Residential Sq Ft
1st Floor Sq Ft
Contractor Phone #
City of Fort Collins License #
City State
Filing # Lot #
Total Building Sq Ft (not including basement)
Comm'I Sq
r Sq Ft
# of Stories Bldg Height
Supervisor Cert #,
Zip
Block # Lot Sq Ft_
Total Garage Sq Ft
# Dwelling Units
Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft 52 3
# of Bedrooms # of FOS aths 3/4 Baths 1/2Baths
Air Conditioning: Yes No Energy in : (Circle appropriate choice) 1. ComCheck
3. ResCheck w/Blower Door 4. E-Star w/Blower, , Qor 5. Prescriptive w/Air Sealing
City of Fort Collins Stock Plan #
UTILITIES INFO:
appropriate option #s
# of Fireplaces
2. ResCheck w/Air Sealing
6. Prescriptive w/Blower Door
Water Tap Size Sewer Tap Size Meteredi�,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) $ Si SSG
Description of Work:
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 F rt Collins ordinances and state laws regulating building construction.
Applicant Signature Print Name f/L'cou,l QQ v!!f Phone
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE