HomeMy WebLinkAbout613 S MELDRUM ST - APPLICATIONS - 6/20/2018City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rtCollins 281 N College Ave • Fort Collins, CO 80522-0580 • Phone 970-221-6760
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BUILDING PERMIT APPLICATION
APPLICATION NUMBER W `� APPLICATION DATE
*Job Site Address 6 13 5 Y`A tA�P,jUnit #.
PROPERTY OWNER INFO (All owner information is required - it is not optional) Phone #
Last name oti O First Name Middle
Street Address 6 13 M tjra �"`- City Y D �� i StateZ_G Zip (-)3 2
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 Builds g Sq Ft ( of including basement) zt 10 d Total Garage Sq Ft
Residential Sq Ft Comm I Sq Ft # of Stones Bldg Height # Dwelling Units
15t Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
3rd Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths '/z 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) $ :g2 d#O
Description of Work
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Contact Name & Phone # of JOBSITE SUPERVISOR
Subcontractor Info
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
t7 - d
Plumbing
Fireplace
Other
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Applicant I hereby acknowledge that I have read this a ation and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fo s nan state laws regulating building construction �,e
Applicant Signatur�:%d Print Namel la i CPL--. A Phone 2iw 3Z
Distnbution White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE