HomeMy WebLinkAbout420 HUDSON CT - APPLICATIONS - 5/18/2010Cityof I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6r`t Collins 281 N College Ave Fort Collins CO 80524 Phone 970 416 2740
www fcgov corn/budding
BUILDING PERMIT APPLICATION
APPLICATION NUMBER /3 IL) 0 a q l0(0 APPLICATION DATE ✓ I / / D
Job Site Address_ 4W 61so,1 C.oui,4 EC VD5'2s Unit #
PROPERTY OWNER INFO (All owner informatlo s equlred - it Is of optional) Phone #
Last name r og� First Name1 I ^'%Ot�-' y / Middle T04A O
Street Address 14 Zo "5a Yt CA City �* Ntrn State Co zip 80
CONTRACTOR INFO Company Name
Lic Holder Name
Mailing
Contractor Phone
City of Fort Collins License #.
City_
LEGAL INFO. y�
Subdivision/PUD �CIS%%41wl wil(s Filing #.
CONSTRUCTION INFO Total Building Sq Ft ( t I d g b in
Residential Sq Ft
1 Floor Sq Ft
Comm I Sq
2 Floor Sq Ft
Supervisor Cart #.
State
Lot # Block # Lot Sq Ft
# of Stories Bldg Height
3 Floor Sq Ft
Total Garage Sq Ft
# Dwelling Units
Unfitshed Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths / Baths / Baths # of Fireplaces
Air Conditioning YeGo0 Energy info ( Circle app pnate choice ) 1 ComCheck ❑ 2 ResCheck w/Air Sealing 11
3 ResCheck w/Blower Door El Simulated Performance Alternative❑ 5 Prescriptive w/Air Sealing11 6 Prescriptive w/ Blower Doofl
City of Fort Collins Stock Plan #
UTILITIES INFO,
List appropriate option
Water Tap Size Sewer Tap Size Metered Yes l:]Nol:l Temp Pedestal Yes❑ No
Type of Heat ❑ Gas Electric Electnc Main Breakjer Size (Residential only) �150 Amp or Less1:1 200 Amp Other
Value of Construction (including labor material 8 profit) $ 1 71 l $ t I II� L () o -4
DescriptiofLl of Work f+�L� S IeC -6 Ao VS2. 54e l 40 6 W JTI+ 0016;O2BDAR0 A-rT4(,l{n
0+\ - ,lOJV?, 0,^� MQIC r..� -r—, L,_.tnt..._
Contact Name 8 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 Fort Collin rtl ances and state laws regulat g building cost uction
I `p
Applicant Signature Print Name � FC qle,! yvlq Phone Cro��lG-b37o
Distribution White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE