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HomeMy WebLinkAbout637 MANSFIELD DR - APPLICATIONS - 6/15/2016COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 570-221-6760 ,. www.fcgov.com/building BUILDING PERMIT APPLICATION APPLICATION NUMBER `� ©!� 6 APPLICATION DATE 1 Z O 1 (O A —Job Site Address v 31 aln5--E1e11 • . fG 490 �Z 9 Unit # ROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # -70 _3 [ I - 7 3 1 1 Last name d toe, I ( First Name �in� Middle y. r Street Address n �,� O D �7 . �i lie 6 ` City T' �0�(1�0�15, State4DZip Z CONTRACTOR INFO: Company Name Contractor Phone # Lic Holder Name Mailing Address_ LEGAL INFO: Subdivision/PUD City of Fort Collins License #. city. Supervisor Cert #. State Zip Filing # Lot # Block # Lot Sq Ft CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft Residential Sq Ft Comm'I Sq 1st Floor Sq Ft Finished Bsmt Sq Ft 2nd Floor Sq Ft # of Stories Bldg Height # Dwelling Units 3rd Floor Sq Ft # of Bedrooms # of Full Baths % Baths Unfiished Bsmt Sq Ft _ '/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 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) $ 15 00 — n Description of Work: b,--&, �n-Je-d of- cJ ze �o Mot e—+r � o- Kai CIPPED)cZ ' el -t u Contact Name & Phone # of JOBSITE SUPERVISOR: Subcontractor Info: II 11 Electrical 1164,15 ''W U2 VO , u0.4� �6echanical a Framer -gym y E �c"e �r� �,^I Lofing Solar 77— Other Concrete Other Plumbing .61►A0Va'ku, r17o6k r 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 o Collins ordinan es and state laws regulating building construction. LQ Applicant Signaturei, Print Name J F4, U)ej Phone 9 %t, Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE