HomeMy WebLinkAbout4454 HOLLYHOCK ST - APPLICATIONS - 7/6/2010COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N College Ave Fort Collins, CO 80522 0580 Phone 970 221 6760
www fcgov com/budding
BUILDING PERMIT APPLICATION
APPLICATION NUMBER APPLICATION DATE n/
Job Site Address 4(qS q L�+ _ K _ , CG 'WO 52%nit #_
PROPERTY OWNER INFO (All owner information is required - it is not optional) Phone # 9 / 3 " 3 1l 1 - ln7 72
Last name L I PMAK1 First Name Jt SS Ic A Middle MAU
Street Address 11-1/ sy H6LLY14Lr k si City & (olthAS State W Zip 86s z6
CONTRACTOR INFO Company Name SG W Contractor Phone #
Lic Holder Name
Mailing Address_
LEGAL INFO
Subdivision/PUD
City of Fort Collins License #_
City
Supervisor Cert #
State Zip
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
1 ' Floor Sq Ft
2 d Floor Sq Ft
# of Stories
3 d Floor Sq Ft
Bldg Height # Dwelling Units
Unfilshed Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths '/s 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 S1ze. (Rest4en pl o ) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor material & profit) $
Description of Work ql&emewerr 2
S
s wo
bam
%)4
Contact Name & P one # of IORSITE SUPERVISOR
Subcontractor Info
Electrical
Framer Roofing
Solar 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 o Fort Coll s ordinance* and state laws regulating building construction/ -gip
Applicant Signature Print Name JESSICA IJpm j) Phone�113'7ilJ (017/1
Distribution White - Office Yellow- Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE