HomeMy WebLinkAbout624 S LOOMIS AVE - APPLICATIONS - 5/22/2019City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740
/ wvvw.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER � )9 03 � to 4 APPLICATION DATE S I as 119
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Job Site Address 624 Loomis Street Unit #
PROPERTY OWNER INFO: (All owner information Is required - It Is not optional) Phone # 970-231-4441
Last name Balzer (Antares Development LLC First Name Barb & Eric Middle
Street Address 5200 Abbey Road city Fort Collins State CO Zip 80526
CONTRACTOR INFO: Company Name Site Industries/Basement Escape Contractor Phone # 970-227-0789
Lic Holder Name Brian Stephenson City of Fort Collins License # 815 Supervisor Cert #
Mailing Address 519 N Overland Trail city FC State CO Zip 80521
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm'I Sq
1s' Floor Sq Ft
2nd Floor Sq Ft
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
31' Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths '/< Baths '/z Baths # of Fireplaces
Air Conditioning: YeGon Energy info: ( Circle appropriate choice ) 1. ComCheck 11 2. ResCheck w/Air Sealing 11
3. ResCheck w/Blower Door ❑ 4. Simulated Performance Alternative❑ 5. Prescriptive w/Air Sealing11 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
List appropriate option
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes ❑NoE] Temp. Pedestal Yes❑ No
Type of Heat: Gas ❑ Electric Electric Main Breaker Size (Residential only) 0150 Amp or Less ❑ 200 Amp Other
Value of Construction (including labor, material & profit) $
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
upJ
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowledge that I F�av ad this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort C III s dinances and state laws-Eegulating building construction. Applicant Signature �� Print Name�/L c ?AL- o7G-7--- Phone �%O - o(4V( -
Distribution: White -Office Yellow -Applicant Pink -WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAPS FROM APPLICATION DATE
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