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HomeMy WebLinkAbout424 PINE ST - APPLICATIONS - 6/30/2015City 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 , 6504-1 1 :�S�5 APPLICATION DATE 4� IJD /) 5 Job Site Address Unit # /0 Z W/11 Kt ,��7 or. s Q7L9 467- 70© a PROPERTY OWNER INFO., (All owner information is required - it is t optional Phone _ Last name�/r,CJe/ First Name D �i�j Street Address !!= f� f%� L��/ City ��/�f/l5 StateZip <2 z / CONTRACTOR INFO: Company Name Contractor Phone # Lic Holder Name City of Fort Collins License # Supervisor Cert #_ Mailing Address City State Zip LEGAL INFO: Subdivision/PUD Filing # Lot # Block # Lot Sq Ft CONSTRUCTION INFO: Total Building Sq Ft (not including basement)-:Z' O, 6-71 Total Garage Sq Ft Residential Sq Ft Comm'I Sq Ft�4�, 5%/ # of Stories � Bldg Height CO r # Dwelling Units _ 1st Floor Sq Ft 2nd Floor Sq Ft 31 Floor Sq Ft Unfiished Bsmt Sq Ft Finished Bsmt Sq Ft # of Bedrooms # of Full Baths 3/4 Baths '/2 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: (Sor No Temp. Pedestal Yes or No Type of Heat: [ Gas ❑ Electric Electric Main Breaker Size (Residential only) Ell 50 Amp or Less ❑ 200 Amp ❑ Other Value of Construction (including labor, material & profit) $�j lSaa Contact Name & Phone # of JOBSITE SUPERVISOR: J-, G f i>Ue��4Gt Subcontractor Info: Electrical Framer Solar Roofing Other Mechanical 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 Cit f ort Collins ordinances and state laws regulating building consttryction. 1 Q n Applicant Signatur Print Name ems/ l'a (� y Phone L 7© -7 �e v Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE