HomeMy WebLinkAbout619 MANSFIELD DR - APPLICATIONS - 10/3/2016CityofCOMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
FOI t Colt
inS 281 N. College Ave. • Fort Collins, CO 80522-0580 - Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER APPLICATION DATE '`' ✓ v
-%job Site Address %i!q De- Unit #
PROPERTY OWNER INFO: (All owner information is required - it Is not optional) Phone # 7:2,0 ?)aLa '5/N70
Last name %2i/G a First Name
elf SrIto /1^ —Middle W l 1 t to �C
Street Address 719 Mtjn5- 12r, City n/ (_(//I)1/7s State-Al'—zipe3662S
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
Contractor Phone #
City of Fort Collins License #
City
State
Filing # Lot # Block #.
Supervisor Cert #
Zip
Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft3� Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft
Finished Bsmt Sq Ft
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
2nd Floor Sq Ft
V Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths /2 Baths # of Fireplaces
Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
4. Simulated Performance Alternative S. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
List appropriate option #s.
Water Tap Size Sewer Tap Size Metered: Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only)
Value of Construction (including labor, material & profit)
*'Description of Work: S tne o i r\ b�c.C', EeEeronc.2 n I
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Temp. Pedestal Yes or No
150 Amp or Less ❑ 200 Amp ❑ Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowledge that I have ead this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort Collins mances and state laws regulating building construction.
AApplicant Signature Print Name jjjfj 11M 4, Phone 310 S Z 2 S-y 3j
Distribution: White —Office Yellow —Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE