HomeMy WebLinkAbout804 BROOKEDGE DR - APPLICATIONS - 4/6/2018Fort Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 15 1 W APPLICATION DATE r V J'K
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Job Site Address $oil 2ootcEA(.E _b2.,rt Unit #
PROPERTY OWNER INFO: (All owner information Is required - It Is not optional) Phone # 970 `i 8 Z- ly o' Z
Last name oGae First Name ST_r HEJJ Middle
Street Address80q 60-aolcEbcE City tl=ercT Q!,oti-'t"s State co zip 3aSLS
CONTRACTOR INFO: Company Name i;srtx Cam.4T"c;-nor.t t _bt3 rcN, t_l.t Contractor Phone # f 70 - (0 90 - I S9 8
Lic Holder Name IR_rtc J k � —uge City of Fort Collins License # 'D2-7-1 Supervisor Cert # 11 It 8 - b Z
Mailing Address 5478 JE6M%tw-- Lo-3 CoviLT City U')%"-Dsoe State Gc Zip seTs't�
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
1 s' Floor Sq Ft
2nd Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft 190
Finished Bsmt Sq Ft 3 39 # of Bedrooms t # of Full Baths 'h Baths , Y: Baths # of Fireplaces
Air Conditioning: YerNo� 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 Metered: Yes E]No1_1 Temp. Pedestal Yes❑ No ❑
Type of Heat: ❑ Gas nElectric Electric Main Breaker Size (Residential only) F-1150 Amp or Less ❑ 200 Amp 00ther
Value of Construction (including labor, material & profit) $ /6 ODO =o
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: ^-�
Electrical /4c/! Ae_—= -&c eontoerv�l Mechanical ^"IA Plumbing a��Ao.cozr- IWr"Bl oe. /NL.
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 Collins ordinances and state laws regulating building construction. ��----�
Applicant Signature �T.2� Print Name=M;S V 2 roJ7-CW Phone
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE