HomeMy WebLinkAbout608 DARTMOUTH CIR - APPLICATIONS - 8/26/2011- City of - COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins '281 N. College Ave: a Fort Collins, CO 80522-0580 9 Phone: 970-221-6760
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BUILDING PERMIT APPLICATION
APPLICATION NUMBER 11' U �J U I✓ APPLICATION
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- 'Job Site Address_ Unit#
'PROPERTY OWNER INFO: (All owner information is required- it is not optional) Phone # -
Last name ve/k%►^ First Name c�am <-1.1 Middle
StreetlAddress___hd *4 Ci r City P_ ,_ 61,111"', State Zip -
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ACONMACT
OR INFO: Company Name Sortshrne Ch?a-c�e. 402 Contractor Phone # 7� - 4r?C1= 2E 6Y
Lic Holder Name /11cile- wa Ati City of Fort Collins License # /►1M-5Y.5 Supervisor Cert #
Mailing Address_ 02 / 3.Z City (f01/05 State
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 Comm'I Sq Ft _ .. _ # of Stories Bldg Height _ _ ___ # Dwelling Units
181 Floor Sq Ft __ __ _ 2"' Floor Sq Ft __ Td Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft _ _ - _ # of Bedrooms # of Full Baths 3/a Baths _ .. _ '/2 Baths # of Fireplaces
Air Conditioning: Yes No Energy info: ( Circle appropriate. choice ) 1. ComCheck 2. ResCheck w/AirSealing
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 # List appropriate option #s
UTILITIES INFO:
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 & profit) $�
Description of Work: •�Jr X /y _[ c k 8 / gibe✓e _c1 r��t
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical ------ Mechanical Mechanical ____. Plumbing _
Framer Roofing _ _ _ Concrete _. Fireplace
Solar Other•. Other ___ _ _ - Other
Applicant: I hereby acknowle that I have - d this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of o llins o s and state laws regulating building co st_ru[ction.
!Applicant Signature __ _ Print NamPhoneQ'�zC
DistribZ
n: White — Office Yellow — Applicant Pink— WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE