HomeMy WebLinkAbout412 SMITH ST - APPLICATIONS - 8/30/2016-` COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F&t'Collm 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER B! U050-11-1) APPLICATION DATE U�'• �O • 011-0 .
Job Site Address &/M
Elf-5 1
Unit #
PROPERTY OWNER. INFO: (All owner information is required — it is not optional) Phone # 970 - -LILl 3 l 36 C
Last name First Name —V;S"AL' g_ Middle ND
Street Address I'i\2 P�i'T to S5%a ciU'r City rORI C_0t't_Lxj& State Zip
CONTRACTOR INFO: Company Name (Ow `i ��� Contractor Phone # 910' L1q3' Lt'36(.
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: tgi w 'ng Sq Ft (not including basement) .Total Garage Sq Ft
Residential Sq Ft 41 Sq Ft # of Stories Bldg Height # Dwelling Units
1" Floor Sq Ft 2nd Floor Sq Ft 3'd Floor Sq Ft Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths 3/ 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 # List appropriate option #s
I.
UTILITIES INFO:
I
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
i.
Value of Construction, (including labor, material & profit) $ clot)
Description of Work: (MUOLUT,S WA&0¢(1 /'D(L4ize ,
IV u It_\6rLGSS WA't-F,_0_. a,-T i RE�o(1LT�. 1��St{ kAA.1\41E A rUEln) LxAjDQt.if
Contact Name & Phone # of JOBSITE SUPERVISOR: _
Subcontractor Info:
Electrical Mechanical
Framer Roofing
Solar I; Other
Applicant: I hereby a
contained herein and
Applicant Signature
7
' 1A_'-,L-r>fL is y+-8.
Concrete
Other
�Zb• Lt43• Lt36to
Plumbing
Fireplace _
Other
that I have read this application and state that the above information is correct and agree to comply with all requirements
Collin�c s pnd state laws regulating building construction.
% Print Name �yaoEG , `E4 t� Phoneotl0'LlL(3'Li31.
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
IS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE