HomeMy WebLinkAbout645 STONEHAM CT - APPLICATIONS - 7/22/2011City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. a Fort Collins, CO 80522-0580 • Phone: 970-291-6760
~\_ www.f6gawconii/building
BUILDING PERMIT APPLICATION
IAPPLICATION NUMBER_ �R APPLICATION DATE
Job Site Address__ _ _ _ _ Unit #
PROPERTY OWNER INFO: (Ail owner information is required - it is not optional) Phone#
Last name b d.NOV,9W First Name ZZ EXT Middle C/i�i9/t'L�S
Street Address /o pis r✓�//A 1rI G City FO�eY CALL1,tJS State' O Zip .Bo_-f'Z S
CONTRACTOR INFO: Company Name
Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address City State Zip
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION- INFO:_ - Total Building. Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft; _ _ _. _ _ __ Comm'I Sq Ft. # of Stories Bldg Height # Dwelling Units
151 Floor Sq Ft
2na Floor Sq Ft
Finished Bsmt Sq Ft # of'Bedrooms
3ro Floor Sq Ft Unfiished Bsrrit Sq Ft
# of Full Baths % Baths % Baths # of Fireplaces
Air Conditioning: Yes No Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck wBlower Door 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan* List appropriate option #s
UTILITIES -INFO:
Water Tap Size _ Sewer Tap Size Metered: Yes or No Temp. Pedestal Yes or No
Type of Neat: Gas Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp F! Other
Value of Construction (including labor, material & profit) $
Description of Work: C D/JST7Ly CT 19W OE A /2 "Y / 2 /
Framer
Roofing
Concrete
Fireplace
Soiar _ Other _ _ Other Other
Applicants 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 nances and state laws regulating building construction. /+
Applicant Signature Print Name 1C�Ji3�°� [,�/bow","i ft� Phone g7D'�y'L/y�
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE