HomeMy WebLinkAbout911 AKIN AVE - APPLICATIONS - 8/16/2011City,of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
forCollins 281 N. College Ave. Fort Collins, CO 80524 • Phone: 970-416-2740
/._ vwvtnRfcgoKcom/building.
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 4 J .l / 65- 0 3 APPLICATION DATE.
Job Site Address_ 911_ Unit #
PROPERTY OWNER•INFO: (All owner Information is required —It Is not optional) Phone #_ 72c. 2Bo 24 19
Last name. 8_6sk.e. fL First Name Middle
Street Address 9:II: Ae_trA City 1=�T C.-* Nt State l e __Zip_SoSl r.
CONTRACTOR INFO: Company Name 0....... rt. 2r Contractor Phone # . 77,o L'Z >$o - 2419
Lid, Holder Name _ _ .. _._ City of Fort Collins License # Supervisor Cert #
Mailing Address _ _ _ _ _ __ ____' _ City State zip _
LEGAL INFO:
Subdivision/PUp _ . _ _ ._- Filing #. . Lot # Block # Lot Sq Ft- _
CONSTRUCTION_ INFO:_ Total Building Sq Ft (not induding basement) 1$00 SF Total Garage Sq Ft 24s4
Residential Sq Ft Comm'I Sq Ft.. # of Stories Bldg Height # Dwelling Units
1e Floor Sq Ft __ _ ___ _ 2ntl Floor Sq Ft 3i° Floor Sq Ft Unfiished Bsmt Sq R
Finished Bsmt Sq Ft #'of Bedrooms # of Full Baths % Baths 1/2 Baths # of Fireplaces_
Air Conditfoning. YeGop Energy Info: ( Circle appropriate choice) 1. CornCheck 2. ResCheck w/AirSealing E
3. ResCheck w/Blower Door F] 4. Simulated Performance Altemativea 5 Prescriptive w/AirSealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan # List appropriate option #s
UTILITIES INFO:
Water Tap Size'. Sewer Tap Site Metered: Yes ❑Nof -1 Temp. Pedestal Yes❑ No
Type of'Heat: Gas -Electric Electric Main Breaker Size (Residential only) E1160Amp or Less �200 Amp Other
Value of Construction (including labor, material &profit) $
Description of Work: 17> 6w_ G -r _ p-a....,��� - .ti.a.; (aE vc t, e... �.y
Contact Name & Phone # of J09SITE SUPERVISOR: "'Z>oc & &S,4e_Vt.. — S. ,2t30 -1. -i 9
SubcontractorInfo:
Electrical _ _ _ ._ __ _ Mechanical ! Plumbing
Framer Roofing _ _ Concrete Fireplace
Solar Other _ _ __ _ _ _ _ _ _ _ _ _ - Other 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 of F ollins ordinances ands a laws,regulating building construction.
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Applicant Signature Print Name wi eG, 8*,c #:+2 Phone 7 'LSc?- 24l 9
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE