HomeMy WebLinkAbout609 SMITH ST - APPLICATIONS - 8/4/2015COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
City of
-CO«II1S
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
wwwAcgov.com/building 493,
BUILDING PERMIT APPLICATION52�.
APPLICATION NUMBER P� �7 O J�4 APPLICATION DATE
Job Site Address G909 5 ull,1 Unit #.
r 0- L18Z-
PROPERTY tO�W�NER INFO_ (All owner information is required - it is not optional) Phone # � G
Last name �(� J&C GAy O c- j � ,, f . first Name C��q� � '-V S I Middle /
Street Address C'o 1 54 . 1--M 'f� ' CI'&nn city ; �� CA� jVlS �Sttattee l�U Zip
CONTRACTOR INFO: Company Name 16L lEJ(� I�U�I�C�G�LYL Contractor Phone# W - 1452 -9gS(7
Lic Holder Name oo/�VILI 1., {L l'�� C City of Fo Collins Licf elnse # /1 Supervisor Cert (#'�
g W5 � S J� City �4 CO IhS State C6 Zip U�
Mailing Address
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 DO�) Comm] Sq Ft # of Stories I Bldg Height # Dwelling Units
1 � Floor Sq Ft
2n" Floor Sq Ft
3r1 Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths '/ Baths '/z Baths # of Fireplaces
Air Conditioning: Yes No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w1Air 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
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal Yes or No
Type of Heat: N Gas ❑ Electric Electric Main Breaker Size (Residential only) V 150 Amp or Less ❑ 200 Amp ❑ Other
tQ
Value of Construction (including labor, material &profit) $ ;eo/, 000
of Work: XV1] �JS
Contact Name & Phone # of JOBSITE SUPERVISOR: G N17`( zek qZb " W bl- q -1 s-`
Subcontractor Info: /d
Electrical OU-0-LAND- %GIVOC- Mechanical ►` kw l / AA .. �fZ— Plumbing l � cZpt1YL/�rC�
Framer e$' Roofing � � Concrete t'�V �yj� �C1FFiit qj '
Solar
Other
Other
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 City of Fort Collins or ces laws regulating building construction.
Applicant Signature Print Name /xu�y/ Phone
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE