HomeMy WebLinkAbout931 FOSSIL CREEK PKWY - APPLICATIONS - 10/30/2014COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. - Fort Collins, CO 80522-0580 - Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION +
APPLICATION NUMBER ` OcAPPLICATION DATE
Job Site Address -5/ tell Ered-7 �h'`�y Unit #
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone
/#
Last name --root First Name d4-1 V 'C-V Middle �j
Street Address �('ir/�/ cif « �`L p� City /Dy'� GO��/i°15 State �7 Zip OU
CONTRACTOR INFO:,Companny Namernv/T / wiyic, t� ri�✓lk% Contractor Phone #'77y
Lic Holder Name / City of Fort License # PZ-53 Supervisor Cerrtt #
Mailing Address �q( w`���/�'�" ��� City f— LD�7S State e!!�d ZipOUS�(�
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including
Total Garage Sq Ft
Residential Sq Ft -7� Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths '/< Baths '/z 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:
Water Tap Size Sewer Tap Size
List appropriate option #s
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) $ /02 el" I
Description of W k: lt'4 J
cree` q e&e &7 - r , varz -ems '
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical 6. Mechanical
Frame7%��� /'OY' 7 Roofing
Solar r. Other
Applicant: I hereby acknowl get at I have read
contained herein and City o 0 olli s ordinan
Applicant Signature
Concrete
Other
Plumbing
Fireplace
Other
application and state that the above information is correct and agree to comply with all requirements
id state laws regulating building construction.
J
Print Name « 1-3Flie�q Phon %70-zz y��O
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE