HomeMy WebLinkAbout4702 PRAIRIE VISTA DR - APPLICATIONS - 10/25/2011City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER I U 1 1D { APPLICATION DATE I0 1QS5 III
Job Site Address%OoZ 'PR41J24 E �► 57qi srE Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 3o3- 3 %t- q60 a
Last name T EO 64ARj td h�( R 0&6 )irst Name Middle �^
Street Address 1.70 ST- �/-�GtLS?i2.�E7 �f00 City DgWVC-I . State W zip88L IIZI,6
CONTRACTOR INFO: Company Name Y,NK Trh'6WJ-X C-357 Contractor Phone # 9 70- 5766 — 05 `f(v
Lic Holder Name 1��
os el i. p5 City of Fort Collins License # Supervisor Cert #
Mailing Address 3 2,1(, 5ocro- Cry Ri)- ! City LDyeLA-op State Ca zip 90557
LEGAL INFO: Subdivision/PUD I-ftQ,twaoy 'Roa&e Filing #_ Lot # 4-1- Block # — Lot Sq Ft 5 3 %
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) /to&/7 Total Garage Sq Ft AoZD
/
Residential Sq Ft J& �-'7 Comm] Sq Ft ! # of Stories Bldg Height o73
/ #Dwelling Units
1st Floor Sq Ft I (g �7 2"d Floor Sq Ft
V Floor Sq Ft
Unfiished Bsmt Sq Ft /Gib
Finished Bsmt Sq Ft # of Bedrooms �3 # of Full Baths � 3/4 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 Orn " ulated 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 J Sewer Tap Size Meter : Yes or
Type of Heat: EFrGas ❑ Electric Electric Main Breaker Size (Residential only)
Value of Construction (including labor, material & profit) $ ! 1 1243
Description of Work:
No Temp. Pedestal Gor No
[ KO Amp or Less ❑ 200 Amp [:]Other
Contact Name & Phone # of JOBSITE SUPERVISOR: 9015 k el"C 9'(i' 56/ — 057k
Subcontractor Info:
Electrical 1�n�/Z CilZk6fe-- Mechanical ! Plumbing?
Framer Imo' y Roofing 6D L j) Concrete 41() OEAt J6 - Fireplace
Solar
Other
Other
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.
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Applicant Signature rint Name &13 �1 El l-A)-S Phone / 7zl, .
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE