HomeMy WebLinkAbout4721 OLT CT - APPLICATIONS - 12/12/2011City 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
APPLICATION NUMBER u I � APPLICATION DATE `HT" 1\
Job Site Address
0Z-T-
Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 72-3 —l/ AI
Last name /kw First Name &1'k Middle
Street Address I �Z- T . nC City l � • a l lby State Z�ip �0r�
CONTRACTOR INFO: Company Name jK�r�4�70� 'F7 L f l �"vJ �� Contractor Phone # '?W-02 —0132—
Lic Holder Name l� ��` /1Y1P, %� City of Fort Collins License Supervisor Cert #
Mailing Address q'707 1�1-rl{ ple- City%(' cdfl/�J State Cso Zip
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
151 Floor Sq Ft
Finished Bsmt Sq Ft
Comm'I Sq
2°d Floor Sq Ft
# of Stories Bldg Height # Dwelling Units
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 orLess ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ 1 i �� ®� -' 50
Description of Work: f 'Nis /:)ai£fYt-�'✓�
Contact Name & Phone # of JOBSITE SUPERVISOR: 1C` L � C 7� Co� 2-y 0j Z
Subcontractor Info: ,n
Electrical Pork, �� Mechanical V 11 e � Plumbing ZlAf�ll
Framer
Solar
Roofing
Other
Concrete
Other
Fireplace
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 Fort Collins ordinances and state laws regulating building construction.
, l
Applicant Signature 4, �7 /� Print Name K �j( Cr,�'er'/ Phone���
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE