HomeMy WebLinkAbout4380 ZIEGLER RD - APPLICATIONS - 1/24/2012COMMUNITY DEVELOPMENT 8 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 /)/1 —3� APPLICATION DATE
Job Site Address q-18o Zri'GL£,o� jeD Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # Q 70 - 2-8 8 - p 3 S't �{
Last nameADAGO TEO- tfA)oL6C,1ES First Name Middle
Street Address 'V 390 7,1E&LCt° K6 City LE7Ri C LL/A)3 State CC) Zip $425 Z. '
CONTRACTOR INFO: Company Name iiS r^Ef CoA)S jlaEOc7t CA) Contractor Phone # 970-221 - 4 ! 9S
Lic Holder Name t rAF-A f 9"7/4 City of Fort Collins License # A -t Supervisor Cert# 241 -8
Mailing Address 1141 kAC4y•vE % ice' hk4 City,CoA4- CQ&1.eQS State GD Zip $OSL*
LEGAL INFO:
Subdivision/PUD PQE'$ oIJ-92LLy 2- Filing # Lot # 2
CONSTRUCTION INFO: Total Building Sq Ft (not including
Block # Lot Sq Ft
Total Garage Sq Ft
Residential Sq Ft c7 Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft
Finished Bsmt Sq Ft
2^d Floor Sq Ft
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths Yz 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) $ 176-, Of,40
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR: GAiQy SW OR06A 470- 2&Fr - ODS-Y
Subcontractor Info: /�
Electrical ICFA1.t) Y � r,a/r, Mechanical 0 S. �7�s/A7F�iQ!/t�G Plumbing Alllz-LIAS �/rJ/r!�✓!�G
Framer Roofing AM4 Concrete A),� Fireplace Ay1'
Solar A2A 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 ort Collins o di n es and stat ws regulating building construction.
Applicant Signature s t��%/rl i� Print Name-$ Zt F !c znP&CCCf D Phone 970-`/ib-80949
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE