HomeMy WebLinkAbout839 CAMPFIRE DR - APPLICATIONS - 5/27/2015City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER kJl / APPLICATIONDATE
Job Site Address 93 9 / �I),qP6r/.E b 4 Unit #.
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #.
Last name P-/T7T1S First Name SCe—Z- k . Middle
Street Address City �T... ['oi G /it/ State 4C Zip LLB
CONTRACTOR INFO: Company Name a f dry retractor Phone # 970 - 3V7- 9,U
Lic Holder Name /" 1607` 4'-L-7rr7rvllr' /' lz'�y o Fort Collins License # D 3 9S /+Supervisor Cert #
Mailing Address .3e -3 (d r*AV6 - G� City G/46 State L2> Zip kJ4-SY
LEGAL INFO.
Subdivision/PUD
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft
1s' Floor Sq Ft
Comm'I Sq
2ntl Floor Sq Ft
# of Stories Bldg Height # Dwelling Units
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft 5' 9 !o # of Bedrooms - # of Full Baths I % Baths % Baths # of Fireplaces
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
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) $ 30; /7 V si• $D
Description of
/S
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: np
Electrical F Dis,ii- i�iue ig rL/sGi. Mechanical �iS/ SzsA.A5 . Plumbing 46Ur4 lot c/r"A/' �
Framer
Solar
Roofing
Other
Concrete
Other
Fireplace
Other
Applicant: I hereby acknowl @@ that I have read thi "' Lion and state that the above information is correct and agree to comply with all requirements
contained herein and City of ForPCollins ordinan and state aws regulating building construction. Ln
170
Applicant Signature Print Name m-S;44w1.1 A L'iaone .37 • 9-S�Z 9.
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE