HomeMy WebLinkAbout2437 NEWPORT CT - APPLICATIONS - 9/20/2016City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rtCollins 281 N. College Ave.. Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 15000 ✓ � 01 APPLICATION DATE (q7,;� 16
Job Site Address o2 y 3 7 11)kwpel Gfi Unit #
PROPERTY OWNER INFO: (All owner information is required -it is not tion�l) Phone # 170 -
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First Name
' " t N Middle
Last name IC_
Street Address / 5 !
City i'� �d i/� s
StateC� Zip
CONTRACTOR INFO: Company Name `\V► J �'`
9-1,,/ 1'1C1 Contractor Phone #
6170 3 10 o!r4l -3
Lic Holder Name �� jerve
K �City of Fort Collins License # G� S
Supervisor Cert #
Mailing Address
City-!�®'�rtCyj5; State Cd Zip
LEGAL INFO:
Subdivision/PUD
Filing # Lot #,
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft Comm'I Sq Ft # of Stories
15' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
V Floor Sq Ft
Block # Lot Sq Ft
_ Total Garage Sq Ft
Bldg Height # Dwelling Units
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths 3/ Baths '/ 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, material & profit) $ �yyy O
Description of Work:
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Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical A >� Mechanical
Framer
Solar
Roofing
Other
Concrete
Other
C
Plumbing
Fireplace
Other
i�
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 Z52-e j L , Print Name �� k(a ��lVs�ir Phone 9�D3�66��g
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE