HomeMy WebLinkAbout4775 BOARDWALK DR - APPLICATIONS - 4/28/2015City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
rr BUILDING PERMIT APPLICATION
APPLICATION NUMBER I �� /t�e'� APPLICATION DATE 2 / L
Job Site Address
Unit #
PROPERTY OWNER INFO: (All owner information is required— it is of optional) Phone #
Last name�M First Name L JAld % Middle
Street Address 2efnX'7 p�r114 C 5 j .. City E✓! '— State zip o g.D
CONTRACTOR INFO: Company Name 0-2-o�,S5-Z Contractor Phone # �3
Lic Holder Name City of Fort Collins License # Supervisor Cert #
(� J C��� �vwC�e, Q
Mailing Address 7 7i� t��e I fCG.� } City �j LLW07 Z State CcD zip
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'I Sq
Is' Floor Sq Ft
Finished Bsmt Sq Ft
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
2nd Floor Sq Ft
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
31 Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths '/4 Baths Y2 Baths # of Fireplaces
Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
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) $
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Description of Work: R 4--F7C/Z //ilia �� L
Contact Name & Phone # of JOBSITE SUPERVISOR: c— 7;zo - .3-.5 / "' 91%0 3
Subcontractor Info:
Electrical
Framer
Solar
Mechanical
Plumbing
Roofing Concrete Fireplace
Gil (Z-Z- �� ZL�T�4 tv;,t-C� w14-c- _5
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 City of Fort C u' s ordinances and state laws regulating building construction. "
Applicant Signature Print Name ��/� 'Q ��� Phone 72
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE