HomeMy WebLinkAbout323 EDWARDS ST - 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 NUMBERR1 /V �V I l3� APPLICATION DATE
Job Site Address "Q5 Uu/cud z St Fad 68A 2 Unit # Q
PROPERTY OWNER INFO: (All owner information is required— it is not optional) Phone # l � C) - H I �I
'
Last name Lae— / (� First Name ��Q��f ! Middle
Street Address 1.5 i�aols t) City &/ 61�fn� State lV zip Cf
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
Contractor Phone #
City of Fort Collins License # Supervisor Cert #.
State zip.
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) /4 It? Total Garage Sq Ft
Residential Sq Ft Comm'[ Sq
15' Floor Sq Ft
Finished Bsmt Sq Ft
Air Conditioning: Yes 0
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
2nd Floor Sq Ft
# of Stories Bldg Height # Dwelling Units
Td Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths '/< Baths '/2 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) $ ( \ •cJ�
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowledge that I have'reA this application and state that the above information is correct and agree to com Wl with all requirements
contained herein and City of F Collins ordin es and state laws regulating building construction. / 4�0 _Y/? _I(➢
Applicant Signature Print Named Mlja Lli1/I o hone 7 J 7
Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater
( toel( Ice 110LAe(I� sa oll
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE GtIO l� S -11 G'i9j)M #} )