HomeMy WebLinkAbout944 CAMPFIRE DR - APPLICATIONS - 3/6/2017City of I I COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 a Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER I 1 0 APPLICATION DATE 3 I(1 11 —I
Job Site Address
Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # to
Last name w vL'% First Name --/+/l 5z' Middle
Street Address q44 �4 vnD� Y- Cityn�-i Cif 11 /t
CONTRACTOR INFO: Company Name Contractor Phone #_
Lic Holder Name
Mailing Address
LEGAL INFO:
City of Fort Collins License #.
State Zip
Supervisor Cert #
State Zip
Subdivision/PUD 9,( Filing # Lot # Block # Lot q
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq YS`
Residential Sq F Comm] Sq Ft # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft 1+4r- 5 2nd Floor Sq Ft 31 Floor Sq Ft C' Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft iOC�D # of Bedrooms Z, # of Full Baths _q6- % Baths 1 /2 Baths -!�-6 # of Fireplaces q
Air Conditioning: es 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 #
List appropriate option
UTILITIES INFO:
Water Tap Size Sewer Tap Size 4.0 Metered JYesl or
Type of Heat: NO Gas ❑ Electric Electric Main Breaker Size (Residential only)
Value of Construction (including labor, material & profit)
No Temp. Pedestal Yes or No
.-150 Amp or Less ❑ 200 Amp ❑ Other
Oc)-Ibb
Description of Work: �► r l�cc S 1 r ' -� f�S �tii �h ( r "�T t K G� G L t;�C7,Z (C/Q (-
Contact Name & Phone # of JOBSITE SUPERVISOR: �Jw �.4�K� q ^2�5� �S
Subcontractor Info:
Electrical SEC-r- ID M �� S ILC� Mechanical
Framer SE-c- Roofing — IA► Concrete
Solar Other - In Other
Plumbing SrcLP--
Fireplace
Other
Applicant: I hereby acknowledge that 1 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 Collins ordinances and state laws regulating building construct' n.,' �j
Applicant Signatur� -�AS Print Name /tN/' r�.liL1�7 PhoneH /U�Pc/i LOt.0 f
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE