HomeMy WebLinkAbout4307 SHADOWBROOKE CT - APPLICATIONS - 11/30/2016F COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
ort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER I lV lJ 1 APPLICATION DATE
Job Site Address
R 0B K e 6hUnit #
PROPERTY OWNER INFO: %(All owner information is required - it is not optional) Phone #
CLast name S" / %li A FirstName
,t! / a Middle
Street Address �/% //i� UGIt/ I�D�/ �)i8 City i �- L /N Stated_Zip 5::40 L5 P G
CONTRACTOR INFO: Company Name (J i��r /l�%V� /V CllS�l•�1ii C6 �a tIV hone # 97P - 4��9i0`1
Lic Holder Name ii7&e /C/ �c/d1/�N/1/ /V City of Fort Collins License #1,9 % Supervisor Cert #
Mailing Address 13, ; 7 9/ City Fle State G Zip
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 Comm'I Sq Ft # of Stories.
15' Floor Sq Ft
Finished Bsmt Sq Ft
2"d Floor Sq Ft
3'd Floor Sq Ft
Bldg Height # Dwelling Units
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/ Blowe,r 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 (including labor, material & profit) $
Description of Work: !ii �[� ��1G / / A%{G � Cd V 8 R
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor
//Info: /l
Electrical �c /6, �/2 c V43;mechanical
Framer !91?,e Roofing IDAL /V kl-1 Concrete
Solar
Other
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowledge that I have read this a lication and state that the above information is correct and agree to comply with all requirements
contained herein and City of ort Collins ordinan s a tate aws regulating building construction. ,,� >
Applicant Signature Print Name A? 41k /� 0��A/k. hone 47/) - 4,F; r 9/PQ
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE