HomeMy WebLinkAbout4809 CHIPPENDALE DR - APPLICATIONS - 8/22/2005w Y BUILDING PERMITS & INSPECTIONS DIVISION
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k 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 �V �( `l APPLICATION DATE
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PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last Name He) Lbta& First NameMW(Z--- MiddlE
Street Address L� a C1g1'ODeA1&L,F- City CO�Ij�S
State C Zip
CONTRACTOR INFO: Company Name fflof` Dp Qcr[ Ides .�/I f� Contractor //Ph►hone # 2—DI ?Z
Lic. Holder Name
/, wv� Eynjecy City of Fort Collins License # bl-2I I Supervisor Cert #
Mailing Address '7CV4 - ft'. /I/L e City 75 COZZ "Nf State�(J ,. Zip 7�
LEGAL INFO:
Subdivision/PUD
Filing # Lot #,
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Block # Lot Sq
Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1st Floor Sq Ft
# of Bedrooms
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Full Baths % Baths '/2 Baths # of Fireplaces
Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
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 ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ C) Y00 V
Description of Work: (Zr / N "rA/Y- TT Ptk<4e 1A 11tC"jf)i%-
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: n
Electrical J-11- EL @C4/iC Mechanical 6"9 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 inances and state laws regulating building construction. /
Applicant Signature Print Name nIGI( 1.11e-/��/ Phone bg2—d132
Distribu White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE