HomeMy WebLinkAbout4226 ROLLING GATE RD - APPLICATIONS - 5/8/2014City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. a Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION q"ERIII 1 Nl r C ,f fl APPLICATION DATE
Job Site Address yM a6 &o4;yQq7e Q)- Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # / 7
Last name f?rk S i►V First
Name Ci7 e1*9 iNA t TOM Middle
Street Address 7aoZG /(O�[i��cfQ�E /✓ City _ or.trf6l1 An State �d Zip Dd_5'7gi
CONTRACTOR INFO::: Company Name KU I is Yt!g k; Contractor Phone # 1/0 6y9?j'
Lic Holder Name AI teu lew r. &I City of Fort Collins License # Ca 6S Supervisor Cert #
Mailing Address 93 -1 Lod St 4�W �+ City io). t Ca�/ tl* Cj State �0 Zip, 06-c-a ,
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including
Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft 2"d Floor Sq Ft 31 Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft Gby # of Bedrooms # of Full Baths % Baths '/z 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
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)
eA,
Contact Name & Phone # of JOBSITE SUPERVISOR: Al eC ' kO 611 Ss 3
Subcontractor Info: {'�
Electrical . A /c f ��Yit C- Mechanical }-t /(-am Plumbing Gdl� //NM �lL Gi
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 FortCollins9 dinances and state laws regulating building construction.
Applicant Signature Print Name Phone 3l0 67 2i
Distribution: White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE