HomeMy WebLinkAbout4213 STARFLOWER DR - APPLICATIONS - 6/9/2016C91,V of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION-
1 � j
APPLICATION NUMBER I ` APPLICATION DATE F
Job Site Address �D c` . Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # L7 `� -2, '
Last name M45-S First Name S Middle
Street Address `� 2�� 5 ����e-r Of City �� �Q I < < �^ J State Co Zip eozol
CONTRACTOR INFO: Company Name
Contractor Phone #
Lic Holder Name City of Fort Collins License #.
Mailing Address City
LEGAL INFO:
Subdivision/PUD
State
Filing # Lot # Block #.
Supervisor Cert #,
Zip
Lot Sq Ft
CONSTRUCTION INFO: QQTotal Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft--7 Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
15' 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 '/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,
labor, material & profit) $ L S op
Description of Work: i�C-�jc(�.ewl'\ ��� Gd��,% L'16'
?Cg
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Mechanical
Plumbing
Framer
Roofing
Concrete
Fireplace
Solar
Other
Other
Other
Applicant: I hereby acknowledge
tha read this application and
state that the above information is
correct and agree to comply
with all requirements
contained herein and City of Fo
olli inane d laws regulating building construction.
Applitarit-'Signature
F-Print.N'ame':- c��^'�
`�S5 Phone:.
_ 71c Z• 3 It
Distribution: White -Office
Yellow- Applicant Pink - WWW/Stormwater
CO C
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE