HomeMy WebLinkAbout1439 FRONT NINE DR - APPLICATIONS - 5/22/2015City 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 2)W a) W1 _ APPLICATION DATE 4G -4719 - 6
Job Site Address
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Unit #
Last nameFirst Name f /� Middle
Street Address 1 3'T 7. A7/tL� ate: City -A e.€J//,'V 5 State Zip gCJ5; —�
G`'' ttav�t`.ylrs�cT - ��r1=so`niracto-I -7
CONTRACTOR INFO:
Company Name r Phone #
Lic Holder Name ,9t7'City of Fort Collins License #7—)n4W Supervisor Cert #
Mailing Address370�1'0 T�ZF`}�, 7Z City��F IJ��� State �C+� Zip �
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 Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1$1 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
3rd Floor Sq Ft
# of Bedrooms # of Full Baths
3/< Baths
Unfiished Bsmt Sq Ft_
'/z 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) $ 18C415- CM11
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
ElectricalL�erai'i�..�r!nGde-15&em— Cs46/lechanical
Framer Roofing
Solar Other
Concrete
Other
Fireplace
Other
Applicant: I hereby acknowledge that I hav read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of F rt Collins o inances and state laws regulating building construction.
Applicant Signatur Print Named UJ i Phone - 25,�7
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE