HomeMy WebLinkAbout621 SYCAMORE ST - APPLICATIONS - 11/14/2016- City of
I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collins 281 N. College Ave. • Fort Collins, CO 80522-OSBO • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER b 14 0 Lf" t) 8 APPLICATION DATE I' I ILi I 10
Job Site Address 1221 SyCitMDiZL S7 Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name KamA" loe ap-ye LFirst Name /',7A1� eiL hlliP Middle
Street Address (a/ / �G1 ap"ZlV )p 'IL.A�/ City 6d /ieodj is State -a) --Zip
CONTRACTOR INFO: Company Name ;T776A) �. )STQj O./Y& lContractor Phone #
Lic Holder Name City of Fort
tCCollins License # Supervisor Cart #
Mailing Address SS - City State_ Zip_
LEGAL INFO: ' 11 I � I �,
Subdivision/PUD W es+ S I Mfftt I ch Filing # ` u Lot # Block # Lot Sq FtA�_
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) / 9 % y Total Garage Sq Ft
Residential Sq Ft Imo_ Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft /10/ 20d Floor Sq Ft D % I 3'" Floor Sq Ft
2 Unfiished Bsmt Sq Ft 9 &&
Finished Bsmt Sq Ft 0 # of Bedrooms 3 # of Full Baths _a, 3/. 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 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. Pedesta es r No
Type of Heat: eGas ❑ Electric Electric Main Breaker Size (Residential only) 2650 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ , 1w U�
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical /Klwce, Mechanical Plumbing
Framer A44kRoofing / Concrete Fireplace
Solar
Other
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 City of rt Colli or ances d state laws regulating builIV
cons coon. qr,2
Applicant Signature Print Name Y Phone 7
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE