HomeMy WebLinkAbout4721 WITHERS DR - APPLICATIONS - 4/12/2016r k COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F®rtMC®llons 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
Y vrww.fcgov.corn/Ibuildling
APPLICATION NUMBER efl l.Lr f 6 ___ APPLICATION DATE V
Job Site Address/ 71 1 th-ws Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # oZ�� /7-/ - G —/7. �/,
Last name C��/ /��'v First Name,/�i C ��/ri/ Middle /l
Street Address- 4/6-; /mil . //ill •z; City /`�� (--�y1&2 S State C<' Zip ! 5. d /
CONTRACTOR INFO: Company Name`L5 / 0 /U_.STo �'I l ril. ���fi'S Contractor Phone # %7L9 4:�7G%
Lic Holder Named / G jam% City of Fort Collins License # % Supervisor Cert#
Mailing Address-,?.!-, 'ff9 GI/. f'/��P Lk,-7 City -, Le -Zip
LEGAL INFO:
Subdivision/PUD ef&a2 d6 Ztf " Filing # Lot # -� ` Block # Lot Sq Ft �A
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) !,2'Total Garage Sq Ft
Residential Sq Ft Comm9 Sq Ft # of Stories_ Bldg Height 13 l # Dwelling Units
Is' Floor Sq Ft 211 Floor Sq Ft _ J 3`1 Floor Sq Ft �� Unfiished Bsmt Sq Ft vw
Finished Bsmt Sq Ft 6� # of Bedrooms S # of Full Baths Baths — '/2 Baths # of Fireplaces l
Air Conditioning: Yet Non Energy info: ( Circle appropriate choice ) 1. ComCheck11 2. ResCheck w/Air Sealing 11
3. ResCheck w/Blower 4Door ❑ 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
List appropriate option
UTILITIES INFO:
ii
Water Tap Size Sewer Tap Size L/ Metered: Yes ENol-1 Temp. Pedestal Yes® No
Type of Heat: Gas nElectric Electric Main Breaker Size (Residential only) R1150 Amp or Less 200 Amp Other
Value of Construction (including labor, material
/& profit) $ &avz,9
Description of Work: -5-1�) �j b,
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
l �
Electrical Mechanical ��/TGi7<� Plumbing
Frame�< J L/,>!12 RoofingConcrete /'Yi /% /I/VC,�%e Fireplace/,,-S r,-/,-2
Solar
Other
-� 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/��l,1�1 Phone -/�'() a 7
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION XPRRIE 160 FLAYS FROI 1 APPLi A7100 DATE