HomeMy WebLinkAbout4112 MOUNT VERNON CT - APPLICATIONS - 9/2/2010COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N College Ave Fort Collins, CO 80522 0580 Phone 970 221 6760
www fcgov cam/budding
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 10b's(nq APPLICATION DATE
Job Site Address 1H/ 2 /'h o vn�'r //,ER CAN GT" Unit #
PROPERTY OWNER INFO (All owner information is 'Fmrequired - it is not optional) Phone #
Last name I /YETI` �� N �st Name Dg2v I i' 5AILPDV Middle
I �+
Street Address �'f' //Z_ I't^ot. �rT (��RN o)J G�ity� GoY /Nc1 State GO ZipB
CONTRACTOR INFO Company Name
Lic Holder Name
Contractor Phone #
City of Fort Collins License # Supervisor Cert #
Mailing Address City.
LEGALINFO
Subdivision/PUD Filing #
CONSTRUCTION INFO Total Building Sq Ft (not including
Residential Sq Ft Comm I Sq
1 •' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
Lot #
State
Block # Lot Sq Ft
Total Garage Sq Ft
# of Stones Bldg Height # Dwelling Units
3 d Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths '/+ Baths /z Baths # of Fireplaces
Air Conditioning Yes No Energy info ( Circle appropnate 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 & profit) $ /01 SD 4)
Contact Name & Phone # of JOBSITE SUPERVISOR
Subcontractor Info
Electrical A r inn 6e,EaTK fL Mechanical /(FOIE I RA/ Go Lo A/Alumbing
Framer rsi2�, 5T2>of�$�/QS —Concrete �� Fireplace
Solar
Other Other Other
Applicant I hereby acknowle�l8� that I hav ejLt
is application and state that the above information is correct and agree to comply with all requirements
contained herein and Cdy rF (t Collin r e laws regulating building construction
Applicant Signature Print Name rtr I(�Phone Ci 7 D �a3
Distribution White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE