HomeMy WebLinkAbout6315 FALL HARVEST WAY - APPLICATIONS - 10/19/2017COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
City of
�F6rt Collins
APPLICATION
Job Site Address
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION DATE I v ' I I
PROPERTY OWNER INFO (All owner information is required — it is not optional) Phone #
Last name K emly/ep `/ First Name Dt�i//YL O s A(h/ KL t't/` Middle
Street Address Cy%S f/�LC h��/?✓ � �✓ `� City Adle lQ(_(1A f State__C�Zlp
CONTRACTOR INFO Company Name {� / }i' Ax (J Contractor Phone #
Lic Holder Name
Mailing
CONSTRUCTION INFO: Total Building Sq Ft
Residential Sq Ft Comm'I Sq
161 Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
# of Bedrooms
Air Conditioning Ye Go Energy
3 ResCheck w/Blower Door n
4 Simulated I
City of Fort Collins Stock Plan #
Water Tap Size Sewer Tap Size _
Type of Heat GasElectric Electric
Value of Construction (including labor, material &
bin
Description of Work
C%
City of Fort Collins License # Supervisor Cart #
_ City �✓�iy��i(�` State (C) Zip �G')g5d
Filing #_ Lot # 5 Block # Lot Sq Ft
Total Garage Sq Ft
# of Stones Bldg Height # Dwelling Units
31"Floor Sq Ft
Unfiished Bsmt Sq Ft
_ # of Full Baths % Baths '/2 Baths # of Fireplaces
( Circle appropriate choice) 1 ComCheck ❑ 2 ResCheck w/Air Sealing ❑
mance Alternative❑ 5 Prescriptive w/Air Sealing ❑ 6 Prescriptive w/ Blower Door
List appropriate option
Metered Yesl:]NoF] Temp Pedestal Yes❑ No❑
Breaker Size (Residential only) 1:1150 Amp or Less ❑ 200 Amp Other
I41J 4-4=
Contact Name & Phone # of JOBW I E SUPERVISOR
L�`Y��� #(L
�UPt f� CDn�t
Subcontractor Info.
Electrical
Mechanical
Plumbing Z6V4EL4-A.bi ?6J/41VlV �
Framer
Roofing IjI14
Concrete
Fireplace
Solar
Other it
Other
Other
Applicant I hereby adcnowledg
that I have read this appiicati
an state that the above information is correct and agree to comply with all requirements
contained herein and City of ort
Ilins ordinances and st a aws ulating building construction
Applicant Signature
j
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Print Name ' 12>A/10
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11�L Phone .�. S25'y
Distribution White —Office Yellow —Applicant Pink —WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE