HomeMy WebLinkAbout646 STOVER ST - APPLICATIONS - 6/8/2011City Ot COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. a Fort Collins, CO 80524 a Phone: 970-416-2740
►�\ www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER I ' O (l APPLICATION DATE G J'R I I
Job Site Address �� S� Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
ll f Last name L . /Gi.%I C-f �• i' First Name q Middle /Cees'
LL r• � �,
Street Address -5 ilk City T�;'f ��' //`/ I S State C Ci Zip
CONTRACTOR INFO: Company Name
Lic Holder Name
Contractor Phone #
City of Fort Collins License #
Mailing Address City
Supervisor Cert #
State Zip {,
Subdivision/PU D Filing # Lot # Block #-1 96 Lot Sq Ft 1 5C O
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq
161 Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
# of Stories IBldg Height # Dwelling Units
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/2 Baths • # of Fireplaces
Air Conditioning: YerNo Energy info:( Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. Simulated Performance Alternative❑ 5. Prescriptive w/Air Sealing S. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
nIMiiti-431:1Yel1
List appropriate option #s
Water Tap Size Sewer Tap Size Metered: Yes ❑Noll Temp. Pedestal Yes❑ No
Type of Heat: aGas ❑Electric Electric Main Breaker Size (Rely) only) �150 Amp or Less �200 Amp Other
Value of Construction (including labor, material & profit)
Description of Work:
l� �/�/ ��i�V
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Mechanical
Plumbing
Roofing Concrete Fireplace
Solar Other
Other
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 sir/ 1 ���/_�'i/ i Print Name fSf i%7� ✓ /1 //X-i Phone 7-57 02—_. � r
Distribution: White -Office Yellow -Applicant Pink -WWW(Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE