HomeMy WebLinkAbout417 N GRANT AVE - APPLICATIONS - 9/8/2016 (2)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
APPLICATION NUMBER 1CJO 9 v APPLICATION DATE 1 7 1
Job Site Address d 12 / V 61'i'T Unit #
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone # 12 o p vl % U3
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Last name First Name v�e Middle
Street Address Ale —City F-T- 6 l Lrr c4 S State C> Zip 17Z$S1Ij
CONTRACTOR INFO: Company Name (�Z^S'7/(-"-W" Contractor Phone # ; l ` () 0 p3
Lic Holder Name T-0E-Qso City of Fort Collins License # S Supervisor Cert #-
Mailing Address �'I t 2 1v G'—I% � (1" �— City F( ��` �S State Co Zip
LEGAL INFO:
Subdivision/PUD
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�✓t�5� `` Filing #.
CONSTRUCTION INFO: Total Building Sq Ft (not including
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Residential Sq Ft I I.s Comm'I Sq Ft
1st Floor Sq Ft 2"d Floor Sq Ft
Finished Bsmt Sq Ft # of Bedrooms
Lot # '( Block #- l jl Lot Sq Ft W
,ent) I Total Garage Sq Ft ' /J
/ ./ t-
# of Stories Bldg Height S/d- # Dwelling Units
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Full Baths --L % Baths '/2 Baths # of Fireplaces
Air Conditioning: Yes dd Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. Simulated Performance Alternative descriptive 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
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only)
Value of Construction (including labor, material & profit) $
Temp. Pedestal Yes or No
❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Description of Work: t! i 4( e,
Contact Name &Phone # of JOBSITE SUPERVISOR: 6elL&CL Xj ( i c - 3
SubcontractorInfo: /� _ f
Electrical R 1`` 'l21 � c— Mechanical / "Ll-Ar Ai- Plumbing
Framer elt-G( Roofing (—C&DC` Concrete G9-4sJ\ Fireplace
Solar
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. 1
Applicant Signature [ G Print Name ��1�L� Phone � L l q V 7 �
Distribution: White — Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE