HomeMy WebLinkAbout508 JANSEN DR - APPLICATIONS - 4/3/2018Fort 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 I ����5 r� APPLICATION DATE
Job Site Address 15045 Sa.r,s`., 1�. Unit #
PROPERTY OWNER INFO: (All owner Information Is required - It is not optional) Phone
Last name Lr, ,-%A z First Name 7 i, y , Middle Z)
Street Address 5045 1�..ns. r, �,r. City �e5e-1 CAnk\�%r,s StateGb Zip Cd-��
CONTRACTOR INFO: Company Name Contractor Phone # 970- 3'�11'6' %1
Lic Holder Name , C.:. : l- � City of Fort Collins License # Supervisor Cert#
Mailing Address 305%y ")A,a C4 SJI 1:CCity V'o.at State C5D Zip 450Sa1-f
LEGAL INFO:
Subdivision/PUD 7IN!..,.a is i 1i--S Filing # Lot # Block # Lot Sq Ft t�L
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comml Sq Ft # of Stories Bldg Height # Dwelling Units
ls' Floor Sq Ft 1 2nd Floor Sq Ft
3m Floor Sq Ft
Unfiished Bsmt Sq Ft :) 66
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths_ '/. Baths Y: Baths - # of Fireplaces
Air Conditioning: YeGo0 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 #s
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes []No❑ Temp. Pedestal Yes❑ No ❑
Type of Heat: ❑ Gas Electric Electric Main Breaker Size (Residential only) Ill50 Amp or Less ❑ 200 Amp Other
Value of Construction (including labor, material & profit) $�
Description of Work: 1 Z�b�61eJi w *w.t_ _ �rirn cam..- L+:a 0- h1*.0, .a-
Contact Name & Phone # of JOBSITE SUPERVISOR: s Gam- -,S!3
Subcontractor Info:
Electrical F4,-%r-1gr,ls Z),%�l Mechanical
Framer Roofing
Solar Other
Plumbing
Concrete r4?%C- "r.c,t"J<-Fireplace
Other
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 Signaltu Print Name J�ei�+ f�t3� i Phone 630-
--Bistrib�i tf hits - Office Yellow - Applicant Pink - W W W/Stormwallter
THIS APPLICATION EXPIRES 180 01YS FROM APPLICATION DATE