HomeMy WebLinkAbout601 JUSTICE DR - APPLICATIONS - 3/7/2016,City ®f COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rt Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
q.a www.fegov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER I IOO I C�5 n APPLICATION DATE ✓Z Ato
Job Site Address 601 .1 vSTicr br'I' 'C Unit #
PROPERTY OWNER INFO: (All owner information is required — it is
not optional) Phone # /� /
Last name /�ii I First Name ` c,a1 Middle 1`Jnhe,7
Street Address 661 Jcs�QI'iYP City For � e-011iAS State Cy Zip "SZG
CONTRACTOR INFO: Company Name
Lic Holder Name
Contractor Phone #
City of Fort Collins License #.
Mailing Address City
LEGAL INFO:
Subdivision/PU
Supervisor Cert #.
State i Zip
Filing # Lot # Block # Lot Sq Ft,
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) TotalGarage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
15' Floor Sq Ft 2nd Floor Sq Ft _
Finished Bsmt Sq Ft # of Bedrooms
3rd Floor Sq Ft
# of Full Baths 3/ Baths
Unfiished Bsmt Sq Ft _
'/z 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 #s.
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
Value of Construction (including labor, material & profit) $.
Description of
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 application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort Collins ordinances and state laws r ating building construction.
Applicant Signature Print Name ! '-V 1 14ffe6f C/ / � Phone
Distribution: White —Office Yellow —Applicant Pink —WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE