HomeMy WebLinkAbout121 S WHITCOMB ST - APPLICATIONS - 6/24/2014 (6)COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fegov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER Ol `O Wl t APPLICATION DATE 0' `�1 l
Job Site Address /off / S %�j / 7�Y`la,�(�n 'ST �` Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 6 2-0 r-2/ O 2,232
Last name l%��L�C�� //� 77 _`/� First
/Name U' 9 - / Middle �+,,
Street Address / tf ' /iL k ro,4) :5 City — l9 ! State W Zip
CONTRACTOR INFO: Company Name Contractor Phone # �J/ e /
Lic Holder Name
City of Fort Collins License # Supervisor Cert #.
Mailing Address City State Zip
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
$its
Residential Sq Ft omm'I Sq Ft
'Is' Floor Sq Ft
Finished Bsmt Sq Ft
2n0 Floor Sq Ft
Filing # Lot # Block # Lot Sq
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
31tl Floor°Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths 3/< Baths Y: 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 or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $
Descriotion of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR: ✓ /w 6'95 co ?—
Subcontractor Info:
Electrical
Mechanical
Plumbing
Framer CAAJ50/U l.•6rl�.S�oofing sJ Concrete Fireplace
Solar 1J I Other r' Other Other
Applicant: I hereby acknowledge th ead this applicatio st that the above information is correct and agree to comply with all requirements
contained herein and City of ollins ordinan and a laws re tin bui nys�truction.
Applicant Signatu PrintName�Ji/Tt'' C,2 Phone
Distribgtion: White - Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE