HomeMy WebLinkAbout6719 HOLYOKE CT - APPLICATIONS - 5/2/2016et -Collins
281 N. College Ave. - Fort Collins,: CO 80524 - Phone: 970-416-2740
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 0� APPLICATION DATE � `�-�
Job Site Address /,,< a ¢. Unit #
PROPERTY OWNER INFO: (All owner information is required - it isnotoptional) Phone # % o Z 7- - i 2 i
Last name A 1 t,-t � First Name NOS AkA-I, Middle
Street Address (a :R / 9 `-k l., a P.-e G /-- City j!57' . State_40_Zip S o S25'
CONTRACTOR INFO: Company Name re 9& f r!y L�� 9 Ce PLS jfN s'o Contractor Phone # 7-0 -5-G G - 3 S 3 3
J Lic Holder Name 01_0 -s City of Fort Collins License # mm . (® L 9 Supervisor Cert # 35:76.04wt
Mailing Address o(r. City / �® �(.�.,. s StateZip !
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) 2. (n 4' Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1 s1 Floor Sq Ft
2nd Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths M2 Baths # of Fireplaces
Air Conditioning: Ye Go Energy info: ( Circle appropriate choice ) 1. ComCheck 11 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. Simulated Performance Alternative ❑ 5. Prescriptive w/Air Sealing ❑ 6. Prescriptive w/ Blower Dool
City of Fort Collins Stock Plan #
UTILITIES INFO:
List appropriate option #s
Water Tap Size Sewer Tap Size Metered: Yes FINor-1 Temp. Pedestal Yes No
Type of Heat:1-1 Gas ❑Electric Electric Main Breaker Size (Residential only) 1:1150 Amp or Less 11200 Amp ❑Other
Value of Construction (including labor, material & profit) $ f s . v e
Description of Work:�224-L6C
Contact Name & Phone # of JOBSITE SUPERVISOR: J.' Ork.c_ s 61..�S '4-✓ S.
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowledge that I have read this ap lication and state that the above information is correct and agree to comply with all requirements
contained herein and City of For ollins ordinances an tate laws regulating building construction.
Applicant Signature Print Name jelaWLA.s (,�. �s .ws Phone g,40.564.3 a3,3
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater