HomeMy WebLinkAbout4918 HINSDALE DR - APPLICATIONS - 8/16/2011COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 8 /! 6 SO /:1 APPLICATION DATE I�D
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Job Site Address % 7 d ffllys%d Q laGy r i Ue- K05AJnit #.
PROPERTY OW`N/ER INFO, (All owner information is required - it isnotoptional) Phone #_ / 7D 1- 19 7
Last name VA101 OSBR 14 //L First Name ENP/ b'04� Middle r •7/ �.
Street Address q 9! 0 17 1 A)S A /rt-E- P 4 City rid RT ifOLC-/NS State LO zip D ✓r.��
CONTRACTOR INFO: Company Name Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cart #
Mailing
LEGAL INFO:
City
Subdivision/PUD Filing # Lot #,
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'I Sq
State
Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
15' Floor Sq Ft 2nd Floor Sq Ft 3`d Floor Sq Ft
Finished Bsmt Sq Ft )1-3 SS # of Bedrooms --L # of Full Baths 1 3/< Baths
Unfiished Bsmt Sq Ft
'/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. Simulated Performance Alternative 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(Residentialonly) ❑ 150 A rmp or LMess ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
Fireplace
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 Fo Collins ordinances and st a laws r gulating building construction. 1/ /
Applicant SignatureG '� _ Print Name W AKA&j Y AA%N Phone
Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE