HomeMy WebLinkAbout622 LESSER DR - APPLICATIONS - 6/19/2018City of
Fort Collins
APPLICATION NUMB
Job Site Address
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
ILDING PERMIT APPLICATION
APPLICATION DATE 10 � L le
Unit #
PROPERTY OWNER INFO:\,(AII owner information is required - it is not optional) Phone # %76. G'9 //-)
Last name (,A-#,kjl/ Ni- First Name R Cl-" Middle -T
Street Address J" �Yts�n- 'y/L CitState <u Zip B�—
CONTRACTOR INFO: Company Name C 0- " 7 " u . -, �Contractor Phone # 5473�^-
Lie Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq_Ft- Comm'I Sq
11 Floor Sq Ft
Finished Bsmt Sq Ft
2nd Floor Sq Ft
City of Fort Collins License #.
Filing # Lot #
Supervisor Cert #.
State
Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
31d Floor Sq Ft
Unfiished Bsmt Sq Ft
# of Bedrooms # of Full Baths % Baths /] 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:
Water Tap Size Sewer Tap Size
List appropriate option
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) $
J
Description of Work: c oSTQ cT cc 1f,e /erivr P-Rc—k-
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 r ina s and state laws regulating building construction.
Applicant Signature 6 Print Name 4 Phone 91 Gp0 3111C
T O�R.�Q S CAMPLLJ✓A- �7 A�� L , cem
Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE