HomeMy WebLinkAbout660 ROLLAND MOORE DR - APPLICATIONS - 7/17/2012 (2)City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
wort Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 870-416-2740
www fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER h I idG' T APPLICTON DATE a' T' -/'/?
C ob Site Address ��- --- r0 Unit #
pPxi (�
(All owner Information is required - It Is not optional) Phone # -4ug -
Last name �bllt bfrand First NameMiddle
Street Addressaw_kn!:A� 4, �wyi 14N City ChQX State((, Zip QbWj
•,
Lic Holder
Mailing
Phone #-Abq - 831-1SS`3
SupervisorCert#3�I1-Ca
_ City hD IDii& state tyL_ zI AML1
LEGAL INFO:
Subdivision/PUD_6 C'S'YtTtf a Sit MAIN Q Filing # NIft Lot #j(A& A Block # NI& Lot Sq Ft Ila�rj
CONSTRUCTION INFO: Total Building Sq Ft (Trot including basement) 140CS112 Total Garage Sq Ft N I
Residential Sq Ft N_..L_ Comm'I Sq Ft I r O5lo # of Stories_L_ Bldg Height_ All Dwelling Units D
111 Floor Sq Ft I,0510 2n° Floor Sq Ft 1-41 A 3n0 Floor.Sq Ft N I W( Unfiished Bsmt Sq Ft N / A
Finished Bsmt Sq Ft N I A # of Bedrooms 0_ # of Full Baths k_ % Baths �_ /Baths Q_ # of Fireplaces _Q
Air Conditioning. YeSHN Eneryyinfo: ( Circle appropriate choke) 1. ComCheck 2. ResCheck w/Air Sealing 11
3. ResCheck w/Blower Door 4. Simulated Performance Alternative[] 6. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door[
City of Fort Collins Stock Plan #
List appropriate option
UTILITIES INFO: t�
Water Tap Size 3)� ► Sewer Tap Size 1 rr Metered: Yes IzNo❑ Temp. Pedestal YesQ No ❑ M
Type of Heat: a Gas Electric Electric Main Breaker Size (Residential only) 0150 Amp or Less 200 Amp ❑Other
Value of Construction (including labor, material & profit) $_-_] �, CMCK� -
. - •... ,.. (I. F . t 1 1 mine
Contact Name & Phone # of JOBSITE SUPERVISOR:
Electrical 9wh irii c Mechanical 0 Al Plumbing (V_tndA nnj
Framer_ N11R U Roofing NJ Concrete j�1,pr Fireplace_ N�lh
Solar Other
Other
Other
Applicant: 1 hereby acknowledge that I have read this application and state that the above Information is coned and agree to comply with all requirements
contained herein and City of Fort C !ins ordinances and state laws regulating building construction. /_ )
Applicant Signature Print Name Stc . I�1Iteb_fcy ipl Phone
Distribution: White - !Mice Yellow - Applicant Pink - W WW/Stormwater
THIR APPLIrATinld FYPIRFR 4An nAYR FRAM APPI.Ir-ATInu nerc