HomeMy WebLinkAbout4719 CREST RD - APPLICATIONS - 6/23/2010City of
art Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970.221-6760 . --
`iTb O -
www.fcgov.com/building vf'
APPLICATION NUMBER 15 1QQ,-il44
Job Site Address 4
BUILDING PERMIT APPLICATION
APPLICATION DATE �' "" `i
Unit #
PROPERTY OWNER INFO: (All owner information is required - it'^^optional) Phone # (� ' -1 G/�JA-
Last name {�( `'�Pi� First Name ia-10� Middle ' Vl�ani:!!�- ,/—
Street Address 41 Iq l ve-lk+12� City ;R- ���//r tip StatelfoZip
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'] Sq
1s' Floor Sq Ft
2nd Floor Sq Ft
Contractor Phone #
City of Fort Collins License #
City.
Supervisor Cert #
State Zip
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3r° Floor Sq Ft
Unfiished Bsmt Sq Ft '-16
Finished Bsmt Sc; Ft 909 # of Bedrooms _;,7 # of Full Baths 3/, Baths /2 Baths # of Fireplaces i
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:
Water Tap Size Sewer Tap Size
List appropriate option
Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker✓ Size (Residential ❑sidential only) 150 Amp or Less ❑ 200 Amp [:]Other
Value of Construction (including labor, material & profit) $ 1 157U
of Work: 2
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical �q�evs j!�P[7�0 Mechanical M1Ia� Plumbing Zmaz
Framer
Solar
Roofing
Other
Concrete
Other
Fireplace
Other
Applicant: I hereby aknowledge that I have read this application and state that the above information is correct and agree to comply with all requirements
contained herein nd of Fort-Co`llins^ordlin nd state laws regulating buildin onstruction. �D)
Applicant Signature �CJ� Print Namea art-C— {�q phone qjO4M
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE