HomeMy WebLinkAbout643 PARLIAMENT CT - APPLICATIONS - 12/20/2017City of I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
/ www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 61 46 90-1 APPLICATION DATE IZ •ZO • ��
Job Site Address U4SYa--1I a-V mP -COI•�, Unit # Q
PROPERTY OWNER INFO: (All owner information is required- it is not optional) Phone # c170-� S's I Jc /
Last name /1 "' v ' First Name Middle
Street Address UC lk3 F t IQ"etv� Vc - - \ Icity -�C�11 / n5 State C& Zip 505
CONTRACTOR INFO: Company Name �� l ( Contractor Phone #
Lic Holder Name
Mailing Add
City of Fort Collins License # Supervisor Cert #
State
LEGAL INFO: �� h-�1`\
Subdivision/PUD_-'[1\5 Filing # Lot # ( Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) /�� a3��1 1. Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft
2nd Floor Sq Ft
31 Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms 5 # of Full Baths ',' 3/< Baths % Baths -I— # of Fireplaces
Air Conditioning: YeNo" Energy info: ( Circle appropriate choice) 1. ComCheck 11 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door l 14. Simulated Performance Alternative) 15. Prescriptive wlAir Sealing" 6. Prescriptive wl Blower DoorU
City of Fort Collins Stock Plan #
List appropriate option
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes "No" Temp. Pedestal Yes❑ 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) $ ,2 / r-� Sb"
—
Con tact.Nanae&Phone # ofJOBSITESUP.ERVI.SOR: e(1 J �1lo-als-st%59
Subcontractor (yl❑nfo: /�toterro�s"lt-fc(h'l� l
n`�'1�`S�pA {Up�
Electrical � W1`'�Ci\QM Mechanical 7Clr (� Plumbing 1.
Framer
Solar
Roofing
Other
Concrete
Fireplace
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 :of Fart Coll' s.o ances,and stafvdaws�.regulating building constructhn.
Applicant Sign Lure Print Name `-1 �" Phone
Distribution: White -Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE