HomeMy WebLinkAbout4380 ZIEGLER RD - APPLICATIONS - 6/18/2014City 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 O�O APPLICATION DATE �- L1
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Job Site Address 422AO 2 e j l t^' 12-4 Unit #
PROPERTY INFO: (All owner information is required - it is not optional) Phone #
Last name AVA62P mf 1 1a-ocao First Name /yam Middle �r,�
6
Street Address `i390 �)� G 0z)0 City ��/ e //fS State 1/Zip
CONTRACTOR INFO: Company Name 8 P. r
,A 1549) Contractor Phone #
Lic Holder Name City of Fort Collins License # Supervisor Cert #
Mailing Address City State Zip
LEGAL INFO:
Subdivision/PUD Filing # Lot # Blloocpk#Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) S�Coy� /V�( kCMAI
Residential Sq Ft Comm'I Sq Ft # of Stories - Bldg Height # Dwelling Units
1s' Floor Sq Ft 2"d Floor Sq Ft 31d Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths 1/2 Baths # of Fireplaces
Air Conditioning: Yes No Energy info: ( Circle appropriate cho'qScriot
mCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. Simulated Performance Alternative ive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan # List appropriate option #s
UTILITIES INFO:
//Water Tap Size Sewer T SizeAl 1A d 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) $ 5 `(.25' 601 O0a
Description of Work: �U[/�
Contact Name &Phone # of JOBSITE SUPERVISO
_Z150� 'NEW fGgVr /A75 El'/577A1e7 IrVVEPL-t.
Subcontractor Info: oyy) / /f r� ueeear 6G elo5 A /�!/ST%�� .
Electrical J ' V Mechanical Plumbing
Framer Roofing Concrete Fireplace
Solar Other Other . Other
Applicant: I hereby acknowle that I have t is application and state that the above information is correct and agree to comply with all requirements
contained herein and City o Co I or and state laws regulating building construction. ' �/ ���yy��
Applicant Signature Print Name 13ac � Vc�l� Phone j76, 57n8 Z/(
White - Office Yellow- Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE