HomeMy WebLinkAbout901 GROUSE CIR - APPLICATIONS - 4/3/2017City of
II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
For t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 6 1 / O' 7 ^' APPLICATION DATE 4 .-.-3' 1 /
Job Site Address 901 "Se Circle. Unit #
PROPERTY OWNER INFO: (All owner information is required - it Is not optional) Phone # LJ os - a) a- i 3 yy
Last name Le)ro First Name &e Middle
Street Address 901 Grouse- Cfetlie. City For + Collins State C o Zip 805 P H
CONTRACTOR INFO: Company Name
Lic Holder Name
Mailing Address
LEGAL INFO:
Contractor Phone #
City of Fort Collins License # Supervisor Cart #
City
Subdivision/PUD Filing # Lot #.
CONSTRUCTION INFO: Total Building Sq Ft (not including
State
Block # Lot Sq Ft
Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
1s' Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths 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 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
List appropriate option
Water Tap Size Sewer Tap Size Metered: es or No Temp. Pedestal Yes or No
Type of Heat: 2&Gas ❑ Electric Electric Main Breaker Size (Residential only) ❑ 150 Amp or Less K 200 Amp ❑ Other
-KValue of Construction (including labor, material & profit) $ 22 500
'` Description of Work: tli'%*C`wn re AOCOX^ cod relnOole 1
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
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 Collins ordinances and state laws regulating building construction.
Applicant Signature / � Print Name �y�� �-6 Phone yo9-a12^ 13W
Distribution: White - Office Yellow - Applicant Pink - WWW/Stonnwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE