HomeMy WebLinkAbout6714 ANTIGUA DR - APPLICATIONS - 8/12/2005BUILDING PERMITS & INSPECTIONS DIVISION
EO. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
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www.fcgov.corwbuilding
City of Fort BUILDING PERMIT APPLICATION
APPLICATION NUMBER PAD Dv q 4 4 I APPLICATION DATE Il , 1 7-0 5
Job Site Address (en ly _4,",& `D, -*3 g Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # ao y—fl hojo
Last Name �/ W �T'r First Name_ 44v6 e\ Middle C+
Street Address (0'714 4-ft! � 1[�V 0 Sf City State Zip 165e157
CONTRACTOR INFO: Company Name
Lic. Holder Name
Mailing Address
LEGAL INFO:
Contractor Phone
City of Fort Collins License # Supervisor Cert #
State Zi
Filing # Lot # Block # Lot Sq
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft Comm'I Sq
1st Floor Sq Ft
2nd Floor Sq Ft
Total Garage Sq
# of Stories Bldg Height # Dwelling Units
Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft* a 169s _
# of Bedrooms I # of Full Baths Y. Baths '/z 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:
List appropriate option
Water Tap 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 11200 Amp ❑ Other
Value of Construction (including labor, material & profit) $
Description of Work: i I!v IOON'1 ���� l''l CIOiGf-
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical B-fCTry.t ' $ IJFI/
C , G Mechanical
Framer
Roofing
Concrete
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. T
Applicant Signature LO�.r--i Print Name-ayty� - • ` qu& Jf1l Phone 204-01 60
D tribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE