HomeMy WebLinkAbout6933 SEDGWICK DR - APPLICATIONS - 7/28/2011City of COMMUNITY DEVELOPMENT & NEIOHBORHOOD SERVICES
rF6rt Collins 281 N. College Ave. a Fort Collins, CO 80522-0580 a Rhone: 970-221.6760
www.fegov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER --- - -- APPLICATION DATE
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Job Site Address „ _ _ c' Unit #
PROPERTY OWNER INFO: (Ali owner Information is required - it is not optional) Phone # i 31 " oc0Wo_
Last name
V—C O _. _ _ _ _ _-_ _ ___ First Name a Middle
Street Address 5fo 4Z. K/ rl4k city 6l1i:r_42 _ State_ --zip --
CONTRACTOR INFO: Company Name __ ( it TCi_ s,. Contractor Phone # 926 7 q -'SOD �
- - - --
Lic Holder Name kuc. City of Fort Collins License # 9z Supervisor Cert# 07
Mailing Address Z 1 �Cd�G�r-aQ '� City State 6 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 Comm1 Sq Ft _ __ _ # of Stones Bldg Height # Dwelling Units
1st Floor Sq Ft._ __ _ 2nd Floor Sq Ft _ 3rd Floor Sq Ft ____ - _ Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths '/2 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 Heat: D Gas 7-Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less E]200 Amp []Other
Value of Construction (including labor, material & profit) $
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Contact Name & Phone # of JOBSITE SUPERVISOR: �m�: 3�ts4 93d
Electrical _ _ _ __ __ Mechanical Plumbing
Framer Roofing Concrete Fireplace
Solar Other Other Other
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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 Collins ordinances and state laws regulating building construction.
Applicant. Signature _- Print Name. ( , a y .171.1 - __ _ Phone
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE