HomeMy WebLinkAbout4625 CHIPPENDALE DR - APPLICATIONS - 5/12/2016QtyOf COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rt Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER ? N (_OC�2�72�®- APPLICATION DATE C)a::5- 1 Z---2-b1 CP
Job Site Address s� � �S� If
Unit #
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PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name First Name D44 it
_ Middle
Street Address 6' tit &- dam/ / 'Pr` City Z-f % • /� State Zip
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing
LEGAL INFO:
Contractor Phone #
City of Fort Collins License #,
Subdivision/PUD Filing # / Lot ##
CONSTRUCTION INFO: Total Building Sq Ft (not including basem/ent) �r1d
State
Block #
Supervisor Cert #,
Zip
Lot Sq Ft
Total Garage Sq Ft
Residential Sq Ft , - Comm'I Sq Ft # of Stories_ Bldg Height # Dwelling Units
1 s' Floor Sq Ft
Finished Bsmt Sq Ft
Air Conditioning:, Yes No
3. ResCheck w/Blower Door
City of Fort Collins' Stock Plan #
UTILITIES INFO:
2nd Floor Sq Ft
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths '/ Baths '/2 Baths # of Fireplaces
Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
Water Tap Size 1 Sewer Tap Size
List appropriate option
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) $ /tom
n of Work:
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Contact Name &. Phone # of JOBSITE SUPERVISOR: h aA/i (J
Subcontractor Info: nq I
Electrical—hhAc1,&h1e— � ._ Mechanical �/►1 S Plumbing �` v'WI
ramer Roofing Concrete Fireplace
Solar v 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 ���-'� L�� Print Name✓�; L �Gi Phone
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE