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HomeMy WebLinkAbout618 REPUBLIC DR - APPLICATIONS - 12/22/2015Fort Collins t' •T.y�.. 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740 www.fcgov.corn/building BUILDING PERMIT APPLICATION APPLICATION NUMBER I SO 2 C )7-:� APPLICATION DATE I; �)Gk ' Is Job Site Address G Iy (�epubi is D s- Unit #. PROPERTY OWNER INFO: (All owner information is required -it isll not optional) Phone # Ya �- 5,?,' OSSs, Last name J V rwy First Name Ust t tJ Middle J05�eP�\ Street Address 6 i �' --e FUbl' C' D C'. City rb c- - Co l l inS State C 6 Zip 7G? 52� CONTRACTOR INFO: Company Name Lic Holder Name Contractor Phone City of Fort Collins License # Supervisor Cert # Mailing Address City State LEGAL INFO: Subdivision/PUD Filing # Lot # Block# Lot Sq Ft CONSTRUCTION INFO: Total Building Sq Ft (not including basement) _-Z-e7 3 rr Total Garage Sq Ft Residential Sq Ft Comm9 Sq Ft # of Stories Bldg Height # Dwelling Units �2 - 15; Floor Sq Ft 2nd Floor Sq Ft 31' Floor Sq Ft Unfiished Bsmt Sq Ft ysi3 F'+ Finished Bsmt Sq Ft 'WAP0 # of Bedrooms # of Full Baths 1 3% Baths 'Y2 Baths # of Fireplaces Air Conditioning: 941 Energy info: ( Circle appropriate choice) 1. ComCheck l--] 2. ResCheck w/Air Sealing ❑ 3. ResCheck w/Blower Door H4. Simulated Performance Alternative❑ 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower DoolC City of Fort Collins Stock Plan # List appropriate option UTILITIES INFO: Water Tap Size Sewer Tap Size Metered: Yes©NO❑ Temp. Pedestal Yes[--] NoEl Type of Heat: ❑Gas Electric Electric Main Breaker Size (Residential only) 1:1150 Amp or Less E1200 Amp ❑Other Value of Construction (including labor, material & profit) $ Z 700 Description of .MA:„ A a Contact Name & Phone # of JOBSITE SUPERVISOR: Subcontractor Info: Electrical _ Mechanical J Plumbing Framer Roofing Concrete Fireplace Solar Other Other Other Applicant: I hereby acknowl ge at I ve r d his application nd state that the above information is correct and agree to comply with all requirements contained herein and City o ortA 1 0 ( in r)ces and state I s regulating building construction. Applicant Signature Print Name )OZNIN )4C-(1-Ck-I Phone y021!'529.05800 ution: White - Office Yellow -Applicant Pink -VWVW/Stormwater