HomeMy WebLinkAbout938 CAMPFIRE DR - APPLICATIONS - 12/15/2016COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
APPLICATION
281 N. College Ave. • Fort Collins, CO 80522-OS80 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
1 ` APPLICATION DATE
Job Site Address Unit #.
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 7 %U - 3 33- o cA p%
Last name SD c-�`i t(1 First Name Qynck)cew t= I n Middle
Street Address Ci'3 $ mo t �r City CZ 1x„,S rSttaa,te L zip -g Q �6 z
CONTRACTOR INFO:
Company Name �j5�1 1 0` 2� cc,14 L�� d h Contractor Phone #
Lic Holder Name �1rO�� �C` I ZJ City of Fort Collins License # 5 q.34 Supervisor Certt## Y-3 Y
Mailing Address J �J I q� coo, �� City �� I I i i.S State C i7 Zip
LEGAL INFO:
Subdivision/PUD-IrL\\\ II tcj Filing # Lot #_jam Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'I Sq
18' Floor Sq Ft
2"d Floor Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft Vl- # of Bedrooms I # 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 labor, material & profit) $ jjd
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: ��pp
Electrical Ak Mechanical F& LA+t-r Plumbing /zi z/ / /MS
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 C I
lins ordinances an s to laws regulating building construction.
Applicant Signature-14. Print Name JGhv� Jc�,\9(` Phone
Distribution: While — Office Yellow — Applicant Pink — WWW/Stormwaler
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE