HomeMy WebLinkAbout4349 KINGSBURY DR - APPLICATIONS - 6/23/2016 (2)O'tyalCOMMUNITY 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
APPLICATION NUMBER f._J 1 �U 1 APPLICATION DATE ®u 1 L� � % e
Job Site Address 458R_Li�S�S� Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # ?)I-E) 16�i o ®-2—
Last name I l `�i� i �� First Name "1Ctb1A*t1— Middle L^A V�_C—KCJE
Street Address "-A�-Act ycN G5 p_wgN 'PK City FT. COW K_% State CO Zip
CONTRACTOR INFO: CRerparry Name Contractor Phone #,
Lic Holder Name ikQ &AE 6W s%WE�Q- City of Fort Collins License #
Mailing Address
LEGAL INFO:
C
Supervisor Cert #
State Zip
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq.FtComm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
31d 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:
Water Tap Size Sewer Tap Size
List appropriate option #s
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
rValue of Construction (including labor, material & profit) $ 2500• C.v�t� �c.�sc�J W ,Oeb c� 1
Description of Work: dzEP�CttJG t�1��Ca1^i�1 ��G�; u5iiz1� e_-,A,kk (—<QF'C)
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Contact Name & Phone # JOBSITE SUPERVISOR:
of
Subcontractor Info:
Electrical
Mechanical
Plumbing
Framer
Roofing
Concrete
Fireplace
Solar
Other
Other
Other
Applicant: I hereby acknowlep6e
at I have a
is a I c i n and state.that the above information
is correct and agree to comply with all requirements
contained herein and City of ort7�kjn�s,,grdi
anc
t t . aws regulating building construction.
Applicant Signature
Print Name Alct-td -
i-• DO_tV c�R Phone � �� I��
White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE