HomeMy WebLinkAbout95 CIRCLE DR - APPLICATIONS - 10/27/2016City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rtCollins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fegov.com/building
BUILDING PERMIT APPLICATION����
APPLICATION NUMBER � V�a 10. ��' r APPLICATION DATE`�'
Job Site Address T�C11r,cle, NE44°rFt-## 8
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PROPERTY OWNER INFO: (All owner information is required — it i n t optional) Phone #
Last name Z_ First Name x/ j Middle �n,ln r ,
tlr� eStreet Address ) n I) , City 1 State W Zip
CONTRACTOR INFO: Corn y Name Q b ont or Phone
Lic Hol ame City of Col' License # Sup Isor Cert #
Ma
iling A ess Cit State
LEGAL INFO:
Subdivision/ ( /� '�� �C�b�, }�� IJ`�� Filing # Lot # 1 / /W Block # Lot Sq FARMW
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3°' Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths 'Y2 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: N/A
/A
Water Tap Size Sewer Tap Size
List appropriate option
Metered: Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only)
Value of Construction (including labor, material & profit) $
Contact Name & Phon # of JOBSITE SUPERVISOR:
Subcontractor Info UIP
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Temp. Pedestal Yes or No
❑ 150 Amp or Less ❑ 200 Amp ❑ Other,
Plumbing
Fireplace
Other
Applicant: I hereby acknowledge that I have re d this application and state that the above information is correct and agree to comply with all requirements
contained herein and Cit o o I in o din nc s and state laws regulating building c nstrucpption. [�f
Applicant Signature V. Print Name GL 7 Phone �—
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Di r vufiWhite — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE