HomeMy WebLinkAbout660 ROLLAND MOORE DR - APPLICATIONS - 7/17/2012City of I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
FOI t Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
www.fegov.com/building
APPLICATION
BUILDING PERMIT APPLICATION
APPLICATION
Job Site Address awl Unit #
«Je�tt_lopet') 1
(All owner Information is required - It Is not optional) Phone # 38 ^ 4 to - 0' s
Last named lle-bmliat First Name VC-d Middle
Street Address2ILitQO at Qmr>r,_%L Zi� IL( City CkDrj&L State .Lt_Zipa$D41
CONTRACTOR INFO: Company NamX a* Al t fAk- &a*t. r, I-L6 Contractor Phone # 1VA -?5SL - ISS9
Lic Holder Namehdrw brmoko -, City of Fort Collins License Supervisor Cart # 33 1-C�c-:b-
Mailing Addressaft pD Qaxiirrft Nrid &"k—c qyt city(�kk(pjj-e- State _ NC Zip cox33•t I
LEGALINFO:
SubdivisioNPUD�yf UYouY (1,{ �E1(k G51L%hS Filing # NIA Lot #Trp Block # N / A Lot Sq Ftjjaal Jr
CONSTRUCTION INFO: Sq Ft (notincluding basement) wive Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
11 Floor Sq Ft
Finished Bsmt Sq Ft
21 Floor Sq Ft
31" Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths 34 Baths # of Fireplaces
A/rCondidoning. YeEoN Energy Info: ( Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing 11
3. ResCheck w/Blower Door 4. Simulated Performance Altemative11 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door[
City of Fort Collins Stock Plan #
List appropriate option
UTILITIES INFO: 0 11/L
Water Tap Size f "� Sewer Tap Size Metered: Yes ❑NoE] Temp. Pedestal Yes❑ No \
Type of Heat: ❑ Gas ❑Electric Electric Main Breaker Size (Residential only) E-1150 Amp or Less a 200 Amp []Other p
41
Value of Construction (including labor, material & profit) $ 3 _�`-t _,
Description of Work: 101)(01 .')a nre 1,} Stnr,r" CLttk _�b b.& 0114R l kAvier_#'L-
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: Nt f "
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
Fireplace
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 Fort Collins ordinances and state laws regulating building construction.
Applicant Signature " Print Name S'iumo NI I llebir" Phone-TOR-4 96-Zs i 1
Distribution: White - Office Yellow - Applicant Pink - W W W/Stormwater
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