HomeMy WebLinkAbout430 BUTCH CASSIDY DR - APPLICATIONS - 10/11/2011BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
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CityofFort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER \D OAPPLICATION DATE 3 I
Job Site Address 436 iArk ep-scd.--.Dr FDr+('J1,ns 00 80524 Unit#
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # C 1(70) Z82 —75- 2Z
Last Name lgqARt t6,61ap hFirst Name_
Street Address 5��\ll1oW Rd
Middle
Cityffir-±enI11n,S State—ED Zip tyn5p(o
CONTRACTOR INFO: Company Name Contractor Phone #
Lic. Holder Name I)raJlnTa City of Fort Collins License #91-fi Supervisor Cert #_
Mailing Address 1307r1ZZ le 9 City r-or+ Cc I I 117 S State 6_ Zip 80527
LEGAL INFO:
Subdivision/PUD
Filing # Lot # Block # Lot Sq
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft Comm'I Sq
1st Floor Sq Ft
# of Bedrooms
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Full Baths 3/4 Baths /3 Baths # of Fireplaces
Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Doorr Y
List appropriate option
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: Rerhwe n ryi rrP-kr a S+ee 1 4-r tr t t lems All WorK i t riiertor
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Contact Name & Phone # of JOBSITE SUPERVISOR: � �'" �o'� r 970) 291L — 21 u
Subcontractor Info:
Electrical
Mechanical
Plumbing
Framer Roofing Concrete Other blj'STInc fit eNwi�
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 / /iiri ��C�lin.,,,A) Print Name RA,] Wt 111 oms Phonel97� Zd4 -0100
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE