HomeMy WebLinkAbout912 MARBLE DR - APPLICATIONS - 2/11/2016Ckv of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building 1. 47q
BUILDING PERMIT APPLICATION KV
APPLICATION NUMBER 15 6.,/ 0(9 ` APPLICATION DATE C2`1 I" l&
Job Site Address 2l2__ /i' &115 Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # d -70 5;4--16P 94 &
Last name r�i / First Name :j2;0^/ Middle r .
Street Address of? 1WI746t->;i' City ' �L State Co Zip j
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address
Contractor Phone #
City of Fort Collins License #.
City
Supervisor Cert #.
State Zip
LEGAL INFO: /
Subdivision/PUDj(,f? y�,% Filing # Lot # I( Block # Lot Sq Ft 7'92(Q
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft
111 Floor Sq Ft
Finished Bsmt Sq Ft
Comm'I Sq
2"d Floor Sq Ft
# of Stories Bldg Height # Dwelling Units
3m Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths 3/ Baths '/2 Baths # of Fireplaces
Air Conditioning: Yes No Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air 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: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
— __., o 10 11 ?'el.-1
Value of Construction (including labor, material & profit) $
Description of Work: Fes{ f'(/���
C
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowledge that I have read this plic on nd state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort Collins yord�inances t I s regulating building construction.
Applicant Signature '► Print Name .7'oV f ; hone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE