HomeMy WebLinkAbout424 PINE ST - APPLICATIONS - 2/15/2012City of II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER `/—O 0 q\' APPLICATION DATE ?jIjI, S7.3 If
Job Site Ad
I
e
Unit #
PROPERTY OWNER INFO: All owner information is required — it is not optional) Phone #
Last came � % f t'Gj VVC( Y-o-r Le'-/'%/'�il C4 "-;,7� , �nc ; Mist �rtQs4�%�t Y. CL5,0
Street Address�7"Z %I� C � ee 70 7i City i f66 / r' 1-S State —Zip
CONTRACTOR INFO: Company Name Contractor Phone #,
Lic Holder Name
City of Fort Collins License # Supervisor Cert #.
Mailing Address City
LEGAL INFO: ��� I�+_.-t-VL(it�)
Subdivision/PUD �IO�>-r 15 ��� �7��C� to �rtlFiling #_
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CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
State Zip
Lot # 5 Block #
Residential Sq Ft Comm'I Sq Ft,;;?O) 3 7I # of Stories Z
1s' Floor Sq Ft / _ sJ 2n° Floor Sq Ft 3� 3rtl Floor Sq Ft
Lot Sq Ft4 F62
Total Garage Sq Ft
Bldg Height # Dwelling Units
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # 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 #
List appropriate option #s
UTILITIES INFO:
11 I/
Water Tap Size /-2- Sewer Tap Size Metered Es
)r No Temp. Pedestal Yes or
Type of Heat: R Gas ❑ Electric Electric Main Breaker Size (Residential❑only) 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ t1 u () D
Description of Work: `rtyy\ Q1,-2 Q (A-u cl G I) () 6Ocn,-- " p, 6 qy, QJQC nu44 4
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
G
Electrical` ���T /%� �'r r tt, Mechanical
Frame JL om a m i'dFVaAlre6j'_ Concrete
Solar
Other
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowledge tha 1 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 C the rdinances and state laws regulating building construction. I
Applicant Signature . Print Name �I 6�deak Phone%1 7_164 ff
rcfs I Acd t_ Cr o
Distribution: White —Office Yellow— Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE