HomeMy WebLinkAbout640 PETERSON ST - APPLICATIONS - 9/10/2018City of I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
FOIrt Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
/ � wvvw.fcgov.com/building
� BUILDING PERMIT APPLICATION
APPLICATION NUMBER h fl 4 1 i l l , APPLICATION DATE . /
Job Site Add
Unit #
PROPERTY OWNER INFO: (All owner information is required -it is not ootional) Phone # 6 % /` / -av s
Last name TTTYCjeC First Name QCR2_C/ Middle
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Street Address �� C0 t-� [1 ST City l-'�xf �L9�/(/I'.`ti State CO
CONTRACTOR INFO: Company Name �i�t�V' l &aaM[' 5 Contractor Phone # ??0 -6%Z — :
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Lic Holder Name Ki I I r—Fa—, -e City of Fort Collins License # Supervisor Cart #
• ••• I/Ir f� "t7 // L1 09 ✓ UfYL' Co • S I
LEGAL INFO:
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
Finished Bsmt Sq Ft
Comm'I Sq
2nd Floor Sq Ft
# of Stories Bldg Height # Dwelling Units
31 Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/2 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:
List appropriate option
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 (including
Description of
, material & profit)
Contact Name & Phone # of JOBSITE SUPERVISOR:. / 1,�� i �2P b �3 04R
Subcontractor Info:
Electrical Mechanical e Plumbing '�
Framer/ r" Roofing Concrete �� Fireplace
Solar
Other
Other
Other
Applicant: I hereby acknowled at I hav?��6ff
pplication and state that the above information is correct and agree to comply with all requirements
contained herein a d"City of CoWns ord state laws regulating building construction. *1 2
Applicant Signa re _ Print Name l 111 Phone�3o—H9L�C-.7�
Distribution: White -Office Yellow -Applicant Pink-WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE