HomeMy WebLinkAbout804 ALTA VISTA ST - APPLICATIONS - 11/29/2011City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rt Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
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APPLICATION NUM
APPLICATION
Job Site Address 7V)" A —I M 1 J (S441 Unit #
PROPERTY OWNER INFO: (All owner information is required - it is
not optional) Phone #
Last name ��'�(ri� C i First Name J etia Middle
Street Address �('�� � I`v' Ulc--k City . t C %IS State —AZ j
CONTRACTOR INFO: Company ame ��Ce v� I Contr ctor Phone #
Lic Holder Name % % / City of Fort Collins Licen# =ftSupervisor Cert #'
Mailing Address ��IV�l� City( t(S State JL Zip Z
LEGAL INFO: %� L �
Subdivision/PUD ,>r(T' 1 � 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
151 Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3`d Floor Sq Ft
Unfiished 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 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) $ �7 �((l� n n
Description of Work: I S�YI o w amcle►e t �P� � i'�� PUS
Q u er KaAj
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowledge that I have read thi icatio tate that the above information is correct and agree to comply with all requirements
contained herein and City of Fort C s ord' and la gulating building construction. Applicant Signature Print Name ��gvv ✓f� Phone 7 Z- J5�
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
HIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE