Loading...
HomeMy WebLinkAbout660 ROLLAND MOORE DR - APPLICATIONS - 7/17/2012 (3)City of I COMMUNITY DEVELOPMENT.B NEIGHBORHOOD SERVICES F6�t Cothns 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740 www.fcgov.com/building BUILDING PERMIT APPLICATION APPLICATION NUMBER O� APPLICATION DA /T -/� t Job Site Address Unit # C� (All owner Information Is required - It Iss not optional) Phone # �-1 ^ lc) kp- a-5 I ) Last name IIt bCa,rtnl First Name l kfx% Middle Street Addressol= &x frLRMd, "- q114 City 11 MrW+6 Statenc,-- Zip oi$a. i i CONTRACTOR INFO: Company Namel Q w/4 (r4{ Cis, 3t ktirl;bn C Contractor Phone # Avg-WSI - ,SSc) Lic Holder Name City of Fort Collins License # Ca - ► as Supervisor Cert# Mailing Address City CbaLVAjP State PiL Zip o 5aijj LEGAL INFO: /` Subdivision/PUDt-r� E L?i7JYC QL ft-Y-% Gl ih t4 Filing # N I Kt Lot # Yg(&A Block # N I K4 Lot Sq Ftj PI CONSTRUCTION INFO: Total Building Sq Ft (riot including basement) I, � y D Total Garage Sq Ft N 1 A Residential Sq Ft N IA Comm9 Sq Ft # of Stories _jBldg Height_# Dwelling Units l" Floor Sq Ft 1,4440 2"tl Floor Sq Ft M I A 3"' Floor Sq Ft N IrA Unfiished Bsmt Sq Ft N I K1 Finished Bsmt Sq Ft N I A # of Bedrooms # of Full Baths '/. Baths 0 % Baths Q_ # of Fireplaces n A/rCondidoning. Ye13No Energy Info: ( Owle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing 3. ResCheck w/Blower Door n 4. Simulated Performance Alternative[] 6. Prescriptive w/Air Sealing[] 6. Prescriptive w/ Blower Door[ City of Fort Collins Stock Plan # List appropriate option 19 Water Tap Size IQ t Ar Sewer Tap Size N I A Metered: Yes ❑✓ Noll Temp. Pedestal Yes© No ❑ Qom. Type of Heat: ❑Gas Electric Electric Main Breaker Size (Residential only) ❑l50 Amp or Less ❑ 200 Amp ❑Other Value of Construction (including labor, material & profit) $ Q rJ gatoo. Qo Description of Contact Name & Phone # of JOBSITE SUPERVISOR: Electrical DPM Mechanical _pp�pg, Plumbing DQn1M4t Framer �J� Roofing W Ilk � Concrete crete 1 k Fireplace nTlace. N I N Solar rj I q- Other Other 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 yofCo ns ordinances and state laws regulating building construction. Applicant Signature PrintNamestQw- HIPhone-W-176- iJ1 Distribution: White - Office Yellow - Applicant Pink - W W W/Stormwater TMISi APPLII'_ATIr11N FYPIQFR ian nay-ct FQAM APPLICATIr1N AATF