HomeMy WebLinkAbout4380 ZIEGLER RD - APPLICATIONS - 9/17/2014 (3)City of
F�o_rt Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER APPLICATION DATE L1YIG1 , f I J
Job Site Address a3°z3 %&-rta2 A% . r-r "At CZ Unit #�q
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone
Last namehK-iD '(Z;L}i n(-,f3rst Name Middle
Street Address Ugg2s A- City IT cow NY-, State CA zip 8015�
CONTRACTOR INFO: Company Name QIJA4 G22.Y38LUcftC)o Contractor Phone # 153--*qG3-'(2$9Pp
Lic Holder Name 8 (t E 411ga� City of Fort Collins License #W-A Supervisor Cart #
Mailing Address 2L10o S. ('mt.OQ4yic, W(TL tkw City ('r&L- State CIO zip
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)-12D SF f CO HE&1QtXCA)- Total Garage Sq Ft NT�v
Residential Sq Ft Comm] Sq
15' Floor Sq Ft-12y SP 2nd Floor Sq Ft
# of Stories Bldg Height # Dwelling Units
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths 3/4 Baths Yz 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 #
UTILITIES INFO:
List appropriate option
Water Tap Size Sewer Tap Size 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)
Description of Wi
Contact Name & Phone # of JOBSITE SUPERVISOR: f (e WSLEYL-
Subcontractor Info:
/
Electrical as
aaj-�IC- Mechanical f�� Plumbing N/ 14
Framer 0/iiC Roofing ,&(A Concrete �� Fireplace
Solar o Other q'aOther 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. A
Applicant Sig Print Name &Af l]�cc�W Phone-rZts'1(4Zq' j395
Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE