HomeMy WebLinkAbout900 ROLLAND MOORE DR - APPLICATIONS - 12/23/2011city, of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. a Fort Collins, CO 80824 a Phone: 970-410-2740
www.fegov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBEP,--...—R I I / Y4� APPLICATION DATE
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PROPERTY
1 OWNER INFO: (All owner Information Is required - It is not optional) Phone # 4N - " q(. - 2Sw
Last namelJNjAACg2-T'A-r jj*XCow"j FL -mrst Name Middle
Street Address 2.100 11CxP0gP R()A-bf Cwff r it City 1114AALAtrC "State� �• zips
CONTRACTOR INFO: Company Name�plaWEt^rrNIA 61R0CJ'IOry , Contractor Phone # -769 - 41 too - 2SQ0
Uc Holder Name City of Fort Collins License Supervisor Cert #
Meiling Address boo RFkfT1ScYl11e� 4114 Clty� cnE State Zip 28Z 1
LEGAL INFO: t� g t3
SubdivislonlPUD Filing# ot# Block#v Lot SgFt j-J41
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CONSTRUCTION INFO*
'Total Building Sq Ft pinse t including bament) aTotal Garage Sq Ft
Residential Sq Ft�`";rComm'I Sq F(� # of Stories Bldg I�- eg,^ 10 %t #Dwelling Urdu _2�
1° Floor Sq R f gy_SL7L241 Floor Sq Fl 31° Floor Sq Ft y`f 6 Unfiished Bsmt Sq Ft
Finished Bond Sq Ft # of Bedrooms (aQ- # of Fug Baths 60 % Baths _ % Baths # of Fireplaces
Air Conditioning: Ye Energy Info: ( Circle appropriate choice) 1. ComChaek o 2. ResCheck w/Air Seallhg 11
3. ResCheck wBlower Door 4. Simulated Performance Alternative[] b. Prescriptive wlAir Seagng ❑ fi. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
List appropriate option
UTILITIES INFO: 1`
Water Tap Size ` Sewer Tap Size Metered: Yea❑No Temp. Pedestal Yes❑ No❑
Type of Heat:Was ❑Elecric Electric Main Breaker Size (Residen ial only) it Amp or Less ❑ 200 Amp ❑Other
is fit
Value of Construction (incurJtns labor, material R profit) %
Subcontractor Info:
Electrical
Framer
Solar
# of JOBSffE SUPERVISOR: -
Mechanical
Roofing
Other
Concrete
Other
Plumbing
Fireplace
Other
Appll= 1 hereby adkn ledge [hot I have read Ih's application and slate that the above information Is correct and agree to comply with all requirements
conlalned herein end C ort C Iins an nd stale laws regulating building construction. �i
Applicant Signatu Print Name 16f((�(� W _ i�:aw\ Phone S&Z 54ff:
$71JL C?jt-"D Distribution: While -Office Yellow -Applicant Pink -VWAV/5lormwater W
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE
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