HomeMy WebLinkAbout4809 BRUMBY LN - APPLICATIONS - 8/31/2017City of II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
/ � www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 1 O �v APPLICATION DATE
Job"Site Addressi LJ0q jlroin by 1-KUnit #.
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name (.. 4 r�iCe"e, First Name �C.,t tv. Middle
Street Address ZIS D`��Y�,H�y /An< City rV+ GOb&/-al S State r_Zip dt 2
CONTRACTOR INFO: Company Name SEA Contractor Phone #
Lic Holder Name
Mailing Address_
LEGAL INFO:
City of Fort Collins License # Supervisor Cart #
City
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 Ft
1s' Floor Sq Ft
Comm] Sq
2nd Floor Sq Ft
# of Stories Bldg Height # Dwelling Units
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished_Bsrnt Sq"Ft -� # of�Bedrooms-,: # of Full Baths '/. Baths) 1 �'/2 Baths #_of_Firep aces)
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'(iricludirig labor, material & profit)
Description- Work:
ContactName &-Pho`ne # of JOBSITE SUPERVISOR:
U
-:7/?-/-674
Subbc—o-nttrractor Info: f /
Electr_ical,l K t ✓IC�S FI CGbY rG -Mechanical-1_& 5 yeAr-to-4 ALIt Plumbing � U04eiS Pfom j b
- -
Framer
Solar
Roofing
Other
Concrete
Other
Fireplace
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 Colling� P
s ordinances and state laws regulating building construction.
ApplicantSignature--- y 1. PPinfNarne f.GJth cp{CGhone 307-2-1 -- %47
-- _,
Distribution: White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE