HomeMy WebLinkAbout4807 LANGDALE CT - APPLICATIONS - 4/29/2016COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
City of
F6rt Collins
APPLICATION NUMBE
281 N. College Ave. - Fort Collins, CO 80522-0580 - Phone: 970-221-6760
www.fcgov.com/building v
BUILDING PERMIT APPL
APPLICATION
Job Site Address �/'cO% /,i r-(C-bWLr C% Unit#
ATION
,:)-I( I I �
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone
Last name EAR I T F z First Name 'S7-€ CJ C— Middle
Street Address 1-193Q % d, pi- c—p4cz- L'%' City FZ , 60 L CAIIS' State Zip 'Sd SZ97
CONTRACTOR INFO: Company Name&Q/-fe45S' )tRCM i,Ff'!5 11-4A i Contractor Phone # 'f 7D
Lic Holder Name C41 C: FC QD 1:1, HAA-F City of Fort Collins License # Supervisor Cert #
Mailing Address 3 3 , At DC--C DR City FeEjO/-f State GD Zip 66f !�
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 AO `Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
111 Floor Sq Ft
Finished Bsmt Sq Ft
2°d Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths '/ 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 #s
Water Tap Size aC(S T Sewer Tap Size i5w(S V Metered Ye or No Temp. Pedestal Yes or Q
Type of Heat: $�nas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less K200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ 0
Description of Work: 8 0<.tOdE= (Q PG t"� KiT, �Ac3/?e(wdoer R5e(«7-
td,*GG... /Vte---[*l &l r- � -,4f-f T_ - N S: ! lam kr�C�rS� c _ -' a "gUaGr 7' sc-nek G� �t1.PRFri�
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical Mechanical Plumbing 400 6,?0/1 4 1-Z P4 duet S
IlA Framers - o,cc j c��. ing Concrete Fireplace
Solar Other x/ %/¢ 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 ordinances and state laws regulating building construction.
Applicant Signature Print Name C-1L/PF62ia J/ jV-4,Q Phone C%76 -2/7 a(;,�9
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE