HomeMy WebLinkAbout600 S WASHINGTON AVE - APPLICATIONS - 12/30/2011city of
II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
�t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fegov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER I �2:a= APPLICATION DATE t g -Ag—/ I —
Job Site
HE
t`f'r /ic
Unit #
PROPERTY OWNER INFO: (All owner information is required -it is not optional)7 Phone # 7 � — 4 77 -4-?
Last name L n , First Name ::Mbt� Middle
Street Address (�/ o I �tc'A(A4T01'—) City ��— State(:�-10 Zip—�
CONTRACTOR INFO:: Company N e-7 %� Cl�Tr Contractor Phone # -ZIA - � 32(D
Lic Holder Name �7�,4 i.t Company
City of Fort Collins License #-1.2 Supervisor Cert #C��
Mailing Address % C) AK y Z �7'% 3City A--C-- State 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 Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft 2nd Floor Sq Ft 31 Floor Sq Ft Unfiished Bsmt Sq Ft
Finished 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 # List appropriate option #s
UTILITIES INFO:
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) $ CJ Description of Work: L L b.c)(A-t(iCDLA) ITr
X-% �.u�� / ,—�- ; «:2 z000i l 2L 2� ,.wn,� C ( 73 211e X O
Contact Name & Phone # of JOBSITE SUPERVISORZt
Subcontractor Info:
Electrical Mechanical Plumbing
Framer Roofing Concrete Fireplace
Solar Other Other Other
Applicant: I hereb have read thi application and state that the above information is correct and agree to comply with all requirements
contained n and City of Fo Collin ordinanc and state laws regulating building construction.
Applicant Signature Print meet�N (�".� ' �LSo Phone
Distri ui ite—Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE