HomeMy WebLinkAbout619 CHERRY ST - APPLICATIONS - 3/10/2017COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER r6 l —1 "
Job Site Address 10111 cAevr
APPLICATION DATE V 3 Q � n
Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name d First Name A a /' Cl Middle
Street Address �i� a1 � Gt�rl� S City EI . LOL1,, j State
CO Zip OS1
CONTRACTOR INFO: Company Name _ ttA �GCen � �ACam Contractor Phone # l"I o —22 �6.Z7 }
Lic Holder Name l l M L : n C1414 / City of Fort Collins License # D2 12 to Supervisor Cart #
Mailing Address PQ. Qmc, Z�I-Z 3 City �4• CDi1,e,S State (f0 Zip OS 27-
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
1 s' Floor Sq Ft
Finished Bsmt Sq Ft
Comm'I Sq
2"d Floor Sq Ft
# of Stories Bldg Height # Dwelling Units
3r1 Floor Sq Ft
Unflished 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 #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, matterial & profit) $ X00
Description of Work: 'D1%n 1�!^� �,/S�!✓�
)nS e mil` (Ow 'rviC-2_-
Contact Name & Phone # of JOBSITE SUPERVISOR:0�
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowledge that
ave read this application and state that the above information is correct and agree to comply with all requirements
contained herein and C
Applicant Signature
fices and state laws regulating building construction.
Print Name/'tL�t✓V�
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Phone Jrb�4�
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Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwaler
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE