HomeMy WebLinkAbout600 MILLER DR - APPLICATIONS - 7/27/2010City of II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collm 281 N College Ave Fort Collins, CO 80522 0580 Phone 970 221 6760
/ www fcgov com/building
r� BUILDING PERMIT APPLIC/1ATION
APPLICATION NUMBER e I �11� �a. APPLICATION DATE �lii �� (�
Job Site Address
1't4 C L L-
Unit #
PROPERTY OWNER INFO (All owner information is required - it is not optional) Phone # 4-6 4- 33n- --
Last name Ll e—+4 t First Name < � Middle
Street Addressc5� L City'QL4Y �� State �L Zip
CONTRACTOR I Company —r= Contractor Phone #
Lic Holder Name ity of Fort Collins License # Supervisor Cert #a6i�2
Mailing Address Z o— A3 "?e9,7*6 71 City State 4:�17C> Zip
LEGALINFO
Subdivision/PUD
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft _
1 ' Floor Sq Ft
Finished Bsmt Sq Ft
Comm I Sq
2 d Floor Sq Ft
# of Stones Bldg Height # Dwelling Units
3 d Floor Sq Ft
Unfilshed Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/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 #s
Water Tap Size Sewer Tap Size Metered Yes or No Temp Pedestal Yes or No
Type of Heat ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp [:]Other
Value of Construction (including labor material 8 profit) $ CD
Descnotion of Work t 1U�TA %-L c ��SS' t /"Ob,j L 8aP-
Contact Name 8 Phone # of JOBSITE SUPERVISOR
Subcontractor Info
Electrical
Framer Roofing
Solar Other
Mechanical
Concrete
Other
Plumbing
Fireplace
Other
it L
Applicant I hereby acknowl tav read this application and state that the above information is correct and agree to comply with all requirements
contained herein and Fort antes and state laws regulating building construction
Applicant Signature Print Name 7�.�w. t�— Phone Zt�
ution White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE