HomeMy WebLinkAbout6713 HOLYOKE CT - APPLICATIONS - 1/12/2015City of COMMUNITY. DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: i970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER b I 5 l/ 0 I ) Is APPLICATION DATE 1
Job Site Address '-JE ]A-o I �kko Y- Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name i V74/ /,- //'' First Name d�G I'� Middle
Street Address ��%l3 /"101yC)k&_ bet- City Fov��f?�tk� State e:!�U zip (0
CONTRACTOR INFO: Company Name
/IF�O Contractor Phone # 6 70)
Lic Holder Name bNO ltz- City of Fort Collins License # Supervisor Cert #
Mailing Address Sao& YPtu.Yu�to+� Gt�u p City /v.d �i��lkS State e!-�O Zip :o16
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 Comm9 Sq Ft # of Stories Bldg Height # Dwelling Units
1 sc Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
31 Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths . % Baths '/2 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 #s
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) ❑ 1150 Amp oor Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ MEN&AQ, 78J T
Description of Work: loe4e_)
Contact Name & Phone # of JOBSITE SUPERVISOR: ✓o e ✓'e �te P7t?✓'4 o-wV%-
Subcontractor Info:
Electrical Mechanical
Framer Roofing
Solar Other
Concrete
Other
Plumbing
Fireplace
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 state laws regulating building construction.
Applicant Signatu \ Print Name Ali% 4 Phone /V -26- k1V
Distribution: White -Office Yellow -Applicant Pink -WWW/Stormwater A-
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE ` 10D