HomeMy WebLinkAbout615 E PLUM ST - APPLICATIONS - 7/31/2015City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone:.970-221-6760
www.fcgov.com/building 9l 27V -, ? 3
BUILDING PERMIT APPLICATION ✓ 0 I
APPLICATION NUMBER APPLICATION DATE__71 S
Job Site Address 6 1J F P
Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name CXII� ��_rLGFirst Name Middle
Street Address ca�-_ City F � eou"&�s State —Zip Wlngi
CONTRACTOR INFO: Company Name Contractor Phone #
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Lic Holder Name e G 1 ff \ Co VL City of Fort Collins License # Supervisor Cert #
Mailing Address G '� CCA OG. NN, City LOV&1 ol11�l State (20 Zip Q5_50
LEGAL INFO: r
Subdivision/PUD Filing # Lot # Block # `?8 Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1" Floor Sq Ft 11V -11 2"d Floor Sq Ft 3rd Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft 5 # of Bedrooms # of Full Baths -3 % Baths __L '/z Baths # of Fireplaces
Air Conditioning: f Se No Energy info:( Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
OResCheck w/Blower Door 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan # List appropriate option #s
UTILITIES INFO:
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Water Tap Size Sewer Tap Size Metered(Les)or No Temp. Pedestal es r No
Type of Heat: Gas ❑ Electric Electric Main Breaker Size `(Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
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Value of Construction (including labor, material & profit) $ 1060
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Description of Work:
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Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical L Mechanical Plumbing
Framer Roofing Concrete Fireplace
Solar �- Other �- Other Other �1
Applicant: I hereby acknowledge that l have read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Col ins ord' maan!lte tm la s regulating building con tion.Applicant Signature Print Name/114=1//-kt/J<JLOC=,--Jephoneo4oe�
Distribution: White -Office Yellow- Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE