HomeMy WebLinkAbout4900 DAKOTA DR - APPLICATIONS - 3/30/2018of
,,.F,`o�rt` Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION A 1o3c6•LfD
APPLICATION NUMBER b k T o aX)- !) APPLICATION DATE .5 v � I o
Job Site Address 4(gco p2. Unit #
PROPERTY OWNER INFO: (All owner information is required - it, iis^not
tooptional) PU
hhone # ��' " "!`�'" Og'
Last name-�2C��U�S'�' First Name V I `A• t 1 4tilii/o2 LA Z- Middle
Street Address �- Qo -DAkd `4 12. City Tnog=_ �.OL-[-L"'� StateC-O--Zip �6
CONTRACTOR INFO: Company Name Kr_pV%,W(X_70Aj Contractor Phone # !9�!D
Lic Holder Name t-li A' City of Fort Collins License # Supervisor Cert #E
Mailing Address _a31 11 44ykj?0IA(! (::A-- City7EW`&CL_1A3 State CI) Zip SOTv_A1(e
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 Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
15t Floor Sq Ft
2nd Floor Sq Ft
3.d Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft ,5-'M— # of Bedrooms 1 # of Full Baths — % Baths _L_ Yz 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. 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, material & profit) $ �( g 4Y9 . O0
Description of Work: G �'k. �Lr�fi UJA i CA 1 t+L7eiJu7Db5 A)E
Contact Name & Phone # of JOBSITE SUPERVISOR: b G-r\ %L T f\ Cho - 2- 1
Subcontractor Info:
Electrical ��� Z�1C G Mechanical ' �'� Plumbing
Framer
Solar
Roofing
Other
Concrete
Other
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 Colli ordinances and,5tatq laws regulating building construction � f�/�f
Applicant Signature Print Name f�C/�J j�. 4- Phone
Distribution White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE