COMMUNITY Development & NEIGHBORHOOD SERVICES 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970-416-2740 www.fcgov.com/building APPLICATION NUMBER______________________________________ APPLICATION APPLICATION APPLICATION APPLICATION APPLICATION NUMBER______________________________________ NUMBER______________________________________ NUMBER______________________________________ NUMBER______________________________________ APPLICATION APPLICATION APPLICATION APPLICATION DATE_____________________________________________ APPLICATION NUMBER__________________________________________ APPLICATION DATE________________________________________ APPLICATION APPLICATION APPLICATION APPLICATION APPLICATION APPLICATION APPLICATION APPLICATION NUMBER______________________________________ NUMBER______________________________________ NUMBER______________________________________ NUMBER______________________________________ NUMBER______________________________________ NUMBER______________________________________ NUMBER______________________________________ NUMBER______________________________________ APPLICATION APPLICATION APPLICATION APPLICATION APPLICATION APPLICATION APPLICATION APPLICATION APPLICATION NUMBER______________________________________ APPLICATION DATE_____________________________________________ DATE_____________________________________________ DATE_____________________________________________ DATE_____________________________________________ APPLICATION NUMBER______________________________________ APPLICATION DATE_____________________________________________ DATE_____________________________________________ DATE_____________________________________________ DATE_____________________________________________ DATE_____________________________________________ DATE_____________________________________________ DATE_____________________________________________ DATE_____________________________________________ DATE_____________________________________________ DATE_____________________________________________ JobJob SiteSite Address_________________________________________ UnitUnit #______________________ Job Job Site Site Address_________________________________________ Job Address_________________________________________ Address_________________________________________ Site Address_________________________________________ Unit Unit #______________________ #______________________ #______________________ Unit #__________________ Job Job Job Site Job Job Job Site Site Address_________________________________________ Site Site Site Address_________________________________________ Address_________________________________________ Address_________________________________________ Address_________________________________________ Address_________________________________________ Address_________________________________________ Unit Unit Unit Unit #______________________ Unit Unit Unit #______________________ #______________________ #______________________ #______________________ #______________________ #______________________ #______________________ Site Address_________________________________________ Unit #______________________ Job Site Address_________________________________________ Unit #______________________ PROPERTY OWNER INFO: (All owner information is required – it is not optional) Phone #_______________________________________ PROPERTY PROPERTY PROPERTY OWNER PROPERTY OWNER OWNER INFO INFO OWNER :INFO : (All (All:owner owner INFO (All owner information :information (Allinformation owner isisinformation required required is required ––itis itisis required not –not it is optional optional not – itoptional is )) not Phone Phone optional ) Phone #_______________________________________ #_______________________________________ ) Phone #_______________________________________ #_________________________________ PROPERTY PROPERTY PROPERTY PROPERTY PROPERTY PROPERTY PROPERTY PROPERTY OWNER OWNER OWNER OWNER OWNER OWNER OWNER OWNER INFO INFO INFO INFO INFO : ::INFO INFO (All :INFO (All : (All (All owner :owner : :owner (All owner (All owner (All information owner owner information owner information information information information information information isis required isis required isrequired required required is isis required required – required it – – it ititis not it is –is –not is not it –it not optional is not itisoptional is optional not optional not optional not optional optional )optional Phone )))) Phone Phone )Phone )Phone ) )Phone Phone #_______________________________________ Phone #_______________________________________ #_______________________________________ #_______________________________________ #_______________________________________ #_______________________________________ #_______________________________________ #_______________________________________ PROPERTY OWNER INFO (All owner information is required ––is it– is not optional Phone #_______________________________________ PROPERTY OWNER INFO: (All owner information isFirst required – it is not optional) Phone #_______________________________________ Last name________________________________ Name_____________________________ Middle __________________________ Last Last name________________________________ name________________________________ Last name________________________________ Last name________________________________ First FirstName_____________________________ Name_____________________________ First Name_____________________________ First Name_____________________________ Middle Middle Middle __________________________ __________________________ __________________________ Middle ____________________ Last Last Last Last name________________________________ name________________________________ Last Last name________________________________ name________________________________ name________________________________ Last name________________________________ name________________________________ name________________________________ First First First First First Name_____________________________ Name_____________________________ First First Name_____________________________ Name_____________________________ First Name_____________________________ Name_____________________________ Name_____________________________ Name_____________________________ Middle Middle Middle Middle Middle Middle __________________________ Middle Middle __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ Last name________________________________ First Name_____________________________ Middle __________________________ Last name________________________________ First Name_____________________________ Middle __________________________ StreetStreet Address__________________________________________ City___________________________ State________Zip____________ Street Street Address__________________________________________ Address__________________________________________ Address__________________________________________ Street Address__________________________________________ City___________________________ City___________________________ City___________________________ City___________________________ State________Zip____________ State________Zip____________ State________Zip___________ State________Zip______ Street Street Street Street Address__________________________________________ Street Address__________________________________________ Street Street Address__________________________________________ Address__________________________________________ Address__________________________________________ Address__________________________________________ Address__________________________________________ Address__________________________________________ City___________________________ City___________________________ City___________________________ City___________________________ City___________________________ City___________________________ City___________________________ City___________________________ State________Zip____________ State________Zip____________ State________Zip____________ State________Zip____________ State________Zip____________ State________Zip____________ State________Zip____________ State________Zip____________ Street Address__________________________________________ City___________________________ State________Zip____________ Street Address__________________________________________ City___________________________ State________Zip____________ INFO:INFO: Company Name __________________________________ Contractor Phone #______________________________ CONTRACTOR INFO: Company Company INFO: Name Company Name __________________________________ __________________________________ Name __________________________________ Contractor Contractor Phone Contractor Phone #______________________________ #____________________________ Phone #_______________________ Company Name __________________________________ Contractor Phone #______________________________ CONTRACTOR CONTRACTOR CONTRACTOR CONTRACTOR INFO: INFO: INFO: INFO: INFO: INFO: Company INFO: INFO: Company INFO: Company Company Company Company Company Name Name Name Name Name __________________________________ Name Name __________________________________ Name __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ Contractor Contractor Contractor Contractor Contractor Contractor Contractor Contractor Phone Phone Phone Phone Phone Phone #______________________________ Phone Phone #______________________________ #______________________________ #______________________________ #______________________________ #______________________________ #______________________________ #_____________________________ CONTRACTOR CONTRACTOR CONTRACTOR CONTRACTOR CONTRACTOR CONTRACTOR CONTRACTOR CONTRACTOR INFO: Company Name __________________________________ Contractor Phone #______________________________ CONTRACTOR INFO: Company Name __________________________________ Contractor Phone #______________________________ CONTRACTOR Lic Holder Name _____________________________________ Cityof of Fort Collins License #___________ Supervisor Cert #___________ Lic Holder Lic Holder Name Lic Name Holder _____________________________________ _____________________________________ Name _____________________________________ City City Fort ofCollins Fort City Collins ofLicense Fort Collins License #___________ License #___________ #___________ Supervisor Supervisor Cert Supervisor #___________ Cert #___________ Cert #_____ Lic Holder Name _____________________________________ City of Fort Collins License #___________ Supervisor Cert #___________ Lic Lic Holder Holder Holder Lic Holder Lic Lic Holder Name Holder Name Holder Name Name Name _____________________________________ Name _____________________________________ Name Name _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ City City City City City of of City Fort of City of City of Fort Fort Fort of Fort Collins ofof Fort Collins Fort Collins Collins Fort Collins Collins Collins License Collins License License License License License License #___________ License #___________ #___________ #___________ #___________ #___________ #___________ #___________ Supervisor Supervisor Supervisor Supervisor Supervisor Supervisor Supervisor Supervisor Cert Cert Cert #___________ Cert Cert Cert #___________ #___________ #___________ Cert #___________ #___________ #___________ #___________ LicLic Holder Name _____________________________________ City of Fort Collins License #___________ Supervisor Cert #___________ Lic Holder Name _____________________________________ City City____________________ of Fort Collins License #___________ Supervisor Cert #___________ Mailing Address________________________________________ State____________ Zip________________ Mailing Mailing Address________________________________________ Mailing Address________________________________________ Address________________________________________ City____________________ City____________________ City____________________ State____________ State____________ State____________ Zip________________ Zip_______________ Zip_________ Mailing Address________________________________________ City____________________ State____________ Zip________________ Mailing Mailing Mailing Mailing Mailing Mailing Address________________________________________ Address________________________________________ Mailing Address________________________________________ Address________________________________________ Address________________________________________ Address________________________________________ Address________________________________________ Address________________________________________ City____________________ City____________________ City____________________ City____________________ City____________________ City____________________ City____________________ City____________________ State____________ State____________ State____________ State____________ State____________ State____________ State____________ State____________ Zip________________ Zip________________ Zip________________ Zip________________ Zip________________ Zip________________ Zip________________ Zip________________ Mailing Address________________________________________ City____________________ State____________ Zip________________ Mailing INFO: Address________________________________________ City____________________ State____________ Zip________________ LEGAL LEGAL LEGAL INFO: LEGAL INFO: INFO: LEGAL INFO: LEGAL LEGAL LEGAL LEGAL LEGAL LEGAL INFO: LEGAL INFO: INFO: INFO: INFO: INFO: INFO: INFO: LEGAL INFO: LEGAL INFO: Subdivision/PUD__________________________________ FilingFiling #__________ Lot#________ #________ BlockBlock #_______ Lot Sq Ft_____________ Subdivision/PUD__________________________________ Filing #__________ Lot #________ Block #_______ Lot Sq Ft_____________ Subdivision/PUD__________________________________ Subdivision/PUD__________________________________ Subdivision/PUD__________________________________ Filing #__________ #__________ Filing #__________ Lot Lot #________ LotBlock #________ #_______ #_______ Block Lot #_______ Sq Lot Ft_____________ Sq Ft_____________ Lot Sq Ft_______ Subdivision/PUD__________________________________ Subdivision/PUD__________________________________ Subdivision/PUD__________________________________ Subdivision/PUD__________________________________ Subdivision/PUD__________________________________ Subdivision/PUD__________________________________ Subdivision/PUD__________________________________ Subdivision/PUD__________________________________ Filing Filing Filing Filing Filing #__________ Filing Filing #__________ Filing #__________ #__________ #__________ #__________ #__________ #__________ LotLot Lot Lot #________ Lot #________ Lot #________ Lot Lot #________ #________ #________ #________ Block Block Block Block Block #_______ Block Block Block #_______ #_______ #_______ #_______ #_______ #_______ #_______ LotLot Lot SqLot Sq Lot Ft_____________ Sq Lot Lot Sq Ft_____________ Sq Ft_____________ Ft_____________ Sq Sq Ft_____________ Ft_____________ Ft_____________ Ft_____________ Subdivision/PUD__________________________________ Filing #__________ Lot #________ Block #_______ Lot Sq Ft_____________ Subdivision/PUD__________________________________ Filing #__________ Lot #________ Block #_______ Lot Sq Ft_____________ (not including basement)__________________________ Total Garage Sq Ft ________________ CONSTRUCTION INFO:INFO: TotalINFO: Building SqFt Ft CONSTRUCTION INFO: Total Building Sq Ft (not (notFt including including (not basement basement (not including basement )__________________________ )__________________________ basement )__________________________ )__________________________ Total TotalGarage Total Garage Garage Total Sq SqFt Ft Garage Sq ________________ ________________ Ft ________________ Sq Ft __________ CONSTRUCTION CONSTRUCTION CONSTRUCTION INFO: Total Building Total Building Total Sq Building Sq Sqincluding Ft (not (not (not including (not including including (not including (not including (not including including basement including basement basement basement basement basement basement )__________________________ basement )__________________________ )__________________________ )__________________________ )__________________________ )__________________________ )__________________________ )__________________________ Total Total Total Total Total Garage Total Total Garage Total Garage Garage Garage Garage Garage Sq Garage Sq Sq Ft ________________ Ft Sq Ft Sq Sq ________________ Ft ________________ ________________ Ft Ft________________ Ft ________________ ________________ ________________ CONSTRUCTION CONSTRUCTION CONSTRUCTION CONSTRUCTION CONSTRUCTION CONSTRUCTION CONSTRUCTION CONSTRUCTION INFO: INFO: INFO: INFO: INFO: INFO: INFO: Total INFO: Total Total Total Building Building Total Total Building Total Building Building Building Building Building Sq Sq Sq Ft Sq Sq Ft Ft Sq Ft Ft Sq Sq Ft Ft Ft (not including basement )__________________________ Total Garage SqSq Ft ________________ CONSTRUCTION INFO: Total Building Sq Ft(not )__________________________ Total Garage Sq Ft ________________ CONSTRUCTION INFO: TotalComm’l BuildingSq SqFt_____________ Ft (not including basement Residential Sq FtSq __________ #of ofStories_______ Stories_______ BldgHeight__________ Height__________ Dwelling Units ___________ Residential Residential Residential Sq Sq Residential Ft Ft __________ __________ Ft __________ Sq Ft __________ Comm’l Comm’l Comm’l Sq SqFt_____________ Ft_____________ Comm’l Sq Ft_____________ Sq Ft_____________ ## of Stories_______ # of Stories_______ # of Stories_______ Bldg Bldg Bldg Height__________ Height__________ Bldg Height__________ ###Dwelling Dwelling # Dwelling Units Units # Dwelling ___________ Units ___________ ___________ Units _____ Residential Residential Residential Residential Residential Residential Residential Sq SqSq Sq Ft Sq Ft__________ Ft Ft __________ Sq Ft Sq Sq __________ __________ __________ Ft FtFt __________ __________ __________ Comm’l Comm’l Comm’l Comm’l Comm’l Comm’l Comm’l Sq Comm’l Sq Sq Ft_____________ Sq Sq Ft_____________ Ft_____________ Sq Ft_____________ Ft_____________ Sq Sq Ft_____________ Ft_____________ Ft_____________ ## of # Stories_______ of ofof Stories_______ #Stories_______ #Stories_______ # of Stories_______ ofof Stories_______ Stories_______ Stories_______ Bldg Bldg Bldg Bldg Bldg Height__________ Bldg Bldg Height__________ Height__________ Bldg Height__________ Height__________ Height__________ Height__________ Height__________ # Dwelling ### #Dwelling Dwelling Dwelling ###Dwelling Dwelling #Dwelling Dwelling Units Units Units ___________ Units Units Units ___________ Units ___________ ___________ ___________ ___________ ___________ ___________ Residential Sq Ft __________ Comm’l Sq Ft_____________ ###of of Stories_______ Bldg Height__________ Dwelling Units ___________ st nd rd# of Stories_______ Bldg Height__________ # Dwelling Units ___________ Sq Ft __________2ndnd Comm’l SqFtFt_____________ Sq Ft Floor Sq Floor Sq 1stResidential st Floor st___________ nd___________ 3 rd __________ Unfinished Bsmt Sq Ft____________ st rd Ft Floor Floor Sq Ft Sq ___________ Floor Ft ___________ Sq Ft ___________ 22ndnd Floor Floor 2ndndndndFloor Sq Floor Sq Ft Ft 2Sq ___________ Sq ___________ Floor Ft _______________ ___________ Sq Ft ___________ 33rdrdrd Floor 3rdrdrd rd Sq Floor Sq 3 Ft Ft Sq __________ __________ Floor Ft __________ Ft __________ Unfinished Unfinished Unfinished Bsmt Bsmt Unfinished Sq Bsmt SqFt____________ Ft____________ Sq Bsmt Ft____________ SqFtFt____________ 11 1 1st Sq 1___________ Floor Sq Ft _______________ Ft 3 Floor Sq FtSq _______________ Unfiished Bsmt Sq ______________ st stFloor st st Ft nd2 nd rdrdFloor nd Floor Floor Sq Floor Floor Sq Floor Ft Sq Ft ___________ Ft Ft ___________ Ft Sq Sq ___________ Sq ___________ ___________ Ft FtFt ___________ ___________ ___________ 22 2Floor 2ndFloor Floor 2 Floor 22Sq Sq Floor Floor Sq Floor Ft Sq Sq Ft Ft Ft Sq Ft ___________ Sq ___________ Sq ___________ ___________ Ft FtFt ___________ ___________ ___________ 3rd3 3rdFloor Floor 33Floor Floor 3Sq Floor Floor Sq Sq Floor Ft Sq Sq Ft __________ Ft Sq Ft Sq Ft __________ Sq __________ __________ Ft Ft __________ Ft __________ __________ __________ Unfinished Unfinished Unfinished Unfinished Unfinished Unfinished Unfinished Bsmt Bsmt Bsmt Bsmt Bsmt Sq Bsmt Bsmt Sq Bsmt Sq Ft____________ SqSq Ft____________ Ft____________ Sq Ft____________ Sq Sq Ft____________ Ft____________ Ft____________ Ft____________ 1 1ststFloor 11stSq 1 Floor Sq Ft ___________ 2nd Floor Sq Ft___________ ___________ 3rd3rd3Floor Floor Sq Ft __________ Unfinished Bsmt Sq Ft____________ 1stst1Floor Ft ___________ 2 Floor Ft ___________ 3of Full Floor Sq Ft_____ __________ Unfinished Bsmt Sq Ft____________ 1 Floor Sq Finished Bsmt SqFt FtSq __________ #of ofSq Bedrooms _____ #of Baths ¾Baths Baths _____ ½Baths Baths _____ ofFireplaces Fireplaces _____ Finished Finished Finished Bsmt Bsmt Finished Sq Bsmt Sq Ft __________ __________ Bsmt Ft __________ Sq Ft __________ ## of Bedrooms Bedrooms # of Bedrooms # of _____ _____ Bedrooms _____ ## ofFull Full _____ # ofBaths Baths Full# Baths of _____ _____ Full_____ Baths ¾ ¾ Baths _____ ¾ Baths _____ _____ ¾_____ Baths ½ ½ Baths _____ ½ Baths _____ _____ ½ _____ Baths ###of of Fireplaces #_____ of Fireplaces # of _____ _____ Fireplaces _____ ___ Finished Finished Finished Finished Finished Finished Finished Bsmt Bsmt Bsmt Bsmt Bsmt Sq Sq Bsmt Bsmt Sq Bsmt Sq Ft Sq Ft __________ Ft Ft __________ Sq Ft Sq Sq __________ __________ __________ Ft Ft Ft __________ __________ __________ # # of # of # Bedrooms of of Bedrooms # Bedrooms # Bedrooms Bedrooms # of of of Bedrooms Bedrooms Bedrooms _____ _____ _____ _____ _____ _____ _____ # _____ # of # # of # Full of of of Full # Full # Full # of Baths Full of of Baths Full Baths Full Baths Full Baths _____ Baths Baths _____ Baths _____ _____ _____ _____ _____ ¾ _____ ¾ Baths ¾ ¾ ¾ Baths Baths Baths ¾ ¾ Baths ¾ _____ Baths Baths Baths _____ _____ _____ _____ _____ ½ _____ Baths ½ ½ Baths ½ Baths Baths ½ ½ Baths ½ Baths _____ Baths Baths _____ _____ _____ _____ _____ #_____ _____ of###Fireplaces of of ##Fireplaces #of Fireplaces of #ofFireplaces of Fireplaces Fireplaces Fireplaces _____ _____ _____ _____ _____ _____ _____ _____ Finished Bsmt Sq Ft __________ # of Bedrooms _____ # of Full Baths _____ ¾ Baths _____ ½ Baths _____ of Fireplaces _____ Finished Bsmt Sq Ft __________ # of Bedrooms _____ # of Full Baths _____ ¾ Baths _____ ½ Baths _____ # of Fireplaces _____ Circle appropriate choice ) 1.)ComCheck ComCheck 2.ResCheck ResCheck w/Air Sealing AirConditioning: Conditioning: Yes Yes No No Energy info:Energy Circle Circle appropriate appropriate choice choice appropriate choice )) 1. 1. choice ComCheck 1. ComCheck ) 1. ComCheck 2. 2. ResCheck 2. ResCheck 2. w/Air w/Air ResCheck Sealing w/Air Sealing Sealing w/Air Sealing Air Air Conditioning: Air Conditioning: Air Conditioning: Yes Yes No No Yes Energy Energy No Energy info: info: (info: ((Circle ( appropriate info: ( Circle Circle Circle Circle appropriate appropriate Circle appropriate appropriate appropriate appropriate appropriate choice choice choice choice choice )choice choice choice ))))1.) 1. ComCheck 1. ))1.)1. ComCheck ComCheck ComCheck 1. 1. ComCheck 1. ComCheck ComCheck ComCheck 2. ResCheck 2. 2.ResCheck 2. ResCheck ResCheck 2. 2. ResCheck 2. ResCheck ResCheck ResCheck w/Air w/Air w/Air Sealing w/Air w/Air w/Air Sealing w/Air Sealing Sealing Sealing Sealing Sealing Air Air Air Conditioning: Conditioning: Conditioning: Conditioning: Air Conditioning: Air Air Conditioning: Conditioning: Conditioning: Yes Yes Yes Yes YesNo Yes No Yes Yes No No No No No Energy Energy Energy Energy Energy Energy Energy info: Energy info: info: info: info: ( info: ((info: (Circle info: ((Circle (appropriate (Circle (Circle Circle appropriate choice 1. ComCheck 2. ResCheck w/Air Sealing Air Conditioning: Yes No Energy info: 3. ResCheck w/Blower Door 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing Air Conditioning: Yes No Energy info: ( 3. 3.ResCheck ResCheck 3. ResCheck 3. w/Blower w/Blower ResCheck w/Blower Door Door w/Blower Door 4. 4.Simulated Simulated Door 4. Simulated 4. Performance Performance Simulated Performance Performance Alternative Alternative Alternative Alternative 5. 5.Prescriptive Prescriptive 5. Prescriptive 5.w/Air Prescriptive w/AirSealing w/Air Sealing Sealing w/Air Sealing 6. 6.Prescriptive Prescriptive 6. Prescriptive 6.w/ Prescriptive w/Blower Blower w/ Blower Door Door w/ Blowe Door 3. 3. ResCheck 3.ResCheck ResCheck ResCheck 3. 3.3. ResCheck ResCheck ResCheck w/Blower w/Blower w/Blower w/Blower w/Blower w/Blower w/Blower w/Blower Door Door Door Door Door Door Door 4.4. 4. 4. Simulated Simulated Simulated Simulated 4. 4.4. Simulated Simulated Simulated Performance Performance Performance Performance Performance Performance Performance Performance Alternative Alternative Alternative Alternative Alternative Alternative Alternative Alternative 5. 5. Prescriptive 5. 5.5. Prescriptive Prescriptive Prescriptive 5. Prescriptive 5.5. Prescriptive Prescriptive Prescriptive w/Air w/Air w/Air w/Air Sealing w/Air w/Air Sealing Sealing w/Air Sealing Sealing Sealing Sealing Sealing 6. Prescriptive 6. 6. 6.Prescriptive 6. Prescriptive Prescriptive 6. 6.Prescriptive 6. Prescriptive Prescriptive Prescriptive w/ w/ Blower w/ w/ Blower Blower w/ w/w/ Blower Blower Blower Door Blower Door Door Door Door Door Door Door 3. ResCheck ResCheck w/Blower Door 4.Simulated Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Blower Door 3. ResCheck w/Blower Door 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door Cityof of Fort Collins Stock Plan#Plan #Stock _____________________ Listappropriate appropriate option #s__________________________________________ City City of City Fort Fort ofCollins Collins Fort City Collins ofStock Stock Fort Collins Stock Plan Plan # _____________________ _____________________ # Plan _____________________ # _____________________ List List List appropriate Listoption appropriate option #s__________________________________________ #s__________________________________________ option #s____________________________________ appropriate option #s__________________________________________ City City City City of of City Fort of Fort City of City Fort Fort of Collins of Collins of Fort Fort Collins Collins Collins Fort Collins Collins Stock Stock Collins Stock Stock Stock Plan Stock Plan Stock Stock Plan Plan # # Plan Plan _____________________ # # Plan _____________________ _____________________ _____________________ _____________________ # # # _____________________ _____________________ _____________________ List List List List appropriate List appropriate List appropriate List appropriate appropriate List appropriate appropriate appropriate option option option option option option #s__________________________________________ option option #s__________________________________________ #s__________________________________________ #s__________________________________________ #s__________________________________________ #s__________________________________________ #s__________________________________________ #s__________________________________________ UTILITIES INFO: City of Fort Collins Stock Plan # _____________________ List appropriate option #s__________________________________________ UTILITIES UTILITIES INFO: UTILITIES INFO: INFO: UTILITIES INFO: City of Fort Collins Stock Plan # _____________________ List appropriate option #s__________________________________________ UTILITIES UTILITIES UTILITIES UTILITIES UTILITIES UTILITIES UTILITIES INFO: INFO: INFO: INFO: INFO: INFO: INFO: INFO: UTILITIES INFO: UTILITIES INFO: Water TapSize Size ___________ Sewer TapSize Size ___________ Metered: Yes or No No Temp. Pedestal Yes or No No Water Water Water Tap Tap Size Tap Water ___________ ___________ Size Tap ___________ Size ___________ Sewer Sewer Sewer Tap Tap Size Tap Sewer ___________ ___________ Size Tap ___________ Size ___________ Metered: Metered: Metered: Yes Yes Metered: or Yes or No or Yes No or Temp. No Temp. Temp. Pedestal Pedestal Pedestal Temp. Yes Yes Pedestal or Yes or No or Yes Noor No Water Water Water Water Tap Water Tap Water Water Tap Tap Size Size Tap Size Tap Size Size Tap ___________ ___________ Size Size ___________ ___________ ___________ Size ___________ ___________ ___________ Sewer Sewer Sewer Sewer Sewer Tap Sewer Tap Sewer Tap Tap Tap Size Size Tap Size Tap Size Size Tap ___________ ___________ Size Size ___________ ___________ Size ___________ ___________ ___________ ___________ Metered: Metered: Metered: Metered: Metered: Metered: Metered: Metered: Yes Yes Yes Yes Yes orYes Yes or or Yes or No orNo No or or No or No No No No Temp. Temp. Temp. Temp. Temp. Temp. Pedestal Temp. Temp. Pedestal Pedestal Pedestal Pedestal Pedestal Pedestal Pedestal Yes Yes Yes or Yes Yes Yes or Yes or No or or No or No orNo No No No Water Tap Size ___________ Sewer Tap Size ___________ Metered: Yes or No Temp. Pedestal Yes or No Water Tap Size ___________ Sewer Tap Size ___________ Metered: Yes or No Temp. Pedestal Yes or No Typeof ofHeat: Heat: Gas Gas Electric Electric MainElectric Breaker SizeBreaker (Residential only) only) 150Amp Amp or150 Less 200 Amp Amp Other Type Type Type of Heat: ofType Heat: Gas of Heat: Gas Electric Electric Gas Electric Electric Electric Electric Electric Main Main Breaker Main Breaker Breaker Main Size Size (Residential (Residential Size (Residential Sizeonly) (Residential only) 150 150 150 Amp only)or Amp or Less Less orAmp Less 200 200 or Less Amp 200 Amp 200 Other Other Amp Other Other Type Type Type Type of of Type Type Heat: of Heat: Type ofHeat: Heat: Heat: of ofof Heat: Heat: Gas Gas Heat: Gas Gas Gas Gas Gas Gas Electric Electric Electric Electric Electric Electric ElectricElectric Electric Electric Electric Electric Electric Electric Main Electric Main Main Main Main Breaker Main Breaker Main Breaker Main Breaker Breaker Breaker Breaker Size Breaker Size Size Size Size (Residential Size (Residential Size (Residential (Residential Size (Residential (Residential (Residential (Residential only) only) only) only) only) 150 only) only) only) 150 150 150 Amp 150 150 Amp 150 Amp Amp orAmp Amp Less or Amp oror Less Less Less or or Less or Less Less 200 Less 200 200 200 Amp 200 200 200 Amp 200 Amp Amp Amp Amp Other Amp Other Other Other Other Other Other Type of Heat: Gas Electric Electric Main Breaker Size (Residential only) 150 Amp or Less 200 Amp Other Type of Heat: Gas Electric Electric Main Breaker Size (Residential only) 150 Amp or Less 200 Amp Other ValueValue ofConstruction Construction (including labor, material &profit) profit) $__________________________________________________________________ Value Value of of Construction ofValue Construction of Construction (including (including (including labor, labor, (including labor, material material material labor, && profit) material & profit) $__________________________________________________________________ $__________________________________________________________________ & $_________________________________________________________________ profit) $____________________________________________________________ Value Value Value Value of of Value Value Value Construction of Construction ofConstruction Construction Construction of ofof Construction Construction Construction (including (including (including (including (including (including (including (including labor, labor, labor, labor, material labor, labor, material labor, material material material material material material && && profit) &profit) profit) profit) &&& profit) $__________________________________________________________________ profit) profit) $__________________________________________________________________ $__________________________________________________________________ $__________________________________________________________________ $__________________________________________________________________ $__________________________________________________________________ $__________________________________________________________________ $__________________________________________________________________ Value of Construction (including labor, material &profit) profit) $__________________________________________________________________ Value of Construction (including labor, material & profit) $__________________________________________________________________ Description of Work :_____________________________________________________________________________________ Description Description Description of of Description Work Work of:_____________________________________________________________________________________ Work of Work:_________________________________________________________________________________ :_____________________________________________________________________________________ :_____________________________________________________________________________________ Description Description Description Description Description Description Description of of Work of of Work ofWork Work Work of of of Work Work Work :_____________________________________________________________________________________ :_____________________________________________________________________________________ :_____________________________________________________________________________________ :_____________________________________________________________________________________ :_____________________________________________________________________________________ :_____________________________________________________________________________________ :_____________________________________________________________________________________ :_____________________________________________________________________________________ Description of Work :_____________________________________________________________________________________ _____________________________________________________________________________________ Description of Work:_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________ _______________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________ _______________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________ _______________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Contact Name & Phone # of JOBSITE SUPERVISOR: _____________________________________________________________________ Contact Contact Contact Name Name Contact Name &&Phone Phone &Name Phone ##of of&JOBSITE JOBSITE # Phone of JOBSITE # SUPERVISOR: of SUPERVISOR: JOBSITE SUPERVISOR: SUPERVISOR: _____________________________________________________________________ _____________________________________________________________________ ____________________________________________________________________ ______________________________________________________________ Contact Contact Contact Contact Contact Contact Name Contact Name Name Name Name & Name & Name Name Phone Phone & &&Phone Phone Phone &&& Phone #Phone #Phone of# of #JOBSITE of of JOBSITE #JOBSITE #JOBSITE of #ofof JOBSITE JOBSITE JOBSITE SUPERVISOR: SUPERVISOR: SUPERVISOR: SUPERVISOR: SUPERVISOR: SUPERVISOR: SUPERVISOR: SUPERVISOR: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ ____________________________________________________________________ Contact Name & Phone # of JOBSITE SUPERVISOR: _____________________________________________________________________ Contact Name &Info: Phone # of JOBSITE SUPERVISOR: _____________________________________________________________________ Subcontractor Subcontractor Subcontractor Subcontractor Subcontractor Info: Info: Info: Info: Subcontractor Subcontractor Subcontractor Subcontractor Subcontractor Subcontractor Subcontractor Subcontractor Info: Info: Info: Info: Info: Info: Info: Info: Subcontractor Info: Subcontractor Info: Electrical ___________________________ Mechanical ______________________________ Plumbing ___________________________ Electrical Electrical Electrical ___________________________ ___________________________ Electrical ___________________________ ___________________________ Mechanical Mechanical Mechanical ______________________________ ______________________________ Mechanical ______________________________ ______________________________ Plumbing Plumbing Plumbing ___________________________ ___________________________ Plumbing ___________________________ _____________________ Electrical ___________________________ Mechanical ______________________________ Plumbing ___________________________ Electrical Electrical Electrical Electrical Electrical Electrical ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical Mechanical ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ Plumbing Plumbing Plumbing Plumbing Plumbing Plumbing Plumbing ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ Electrical ___________________________ Mechanical ______________________________ Plumbing ___________________________ Electrical ___________________________ Mechanical ______________________________ Plumbing ___________________________ Framer ____________________ Roofing ____________________ Concrete ____________________ Fireplace _____________________ ____________________ Concrete ____________________ Fireplace _____________________ Framer Framer Framer ____________________ ____________________ Framer ____________________ ____________________ Roofing Roofing Roofing ____________________ Roofing ____________________ ____________________ Concrete Concrete ____________________ Concrete ____________________ ____________________ Fireplace Fireplace _____________________ Fireplace _____________________ _______________ Framer ____________________ Roofing ____________________ Concrete ____________________ Fireplace _____________________ Framer Framer Framer Framer Framer ____________________ Framer ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ Roofing Roofing Roofing Roofing Roofing Roofing ____________________ Roofing ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ Concrete Concrete Concrete Concrete Concrete Concrete Concrete ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ Fireplace Fireplace Fireplace Fireplace Fireplace Fireplace Fireplace _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ Framer ____________________ Roofing ____________________ Concrete ____________________ Fireplace _____________________ Framer ____________________ Roofing ____________________ Concrete ____________________ Fireplace _____________________ SolarSolar ______________________ OtherOther ______________________ OtherOther _____________________ OtherOther _____________________ Solar Solar ______________________ ______________________ ______________________ Solar ______________________ Other Other ______________________ ______________________ ______________________ Other ______________________ Other Other _____________________ _____________________ _____________________ Other _____________________ Other Other _____________________ _____________________ _____________________ Other ________________ Solar Solar Solar ______________________ Solar Solar ______________________ Solar ______________________ ______________________ ______________________ ______________________ ______________________ Other Other Other Other ______________________ Other Other Other ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ Other Other Other Other _____________________ Other Other Other _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ Other Other Other Other _____________________ Other Other Other _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ Solar ______________________ Other ______________________ Other _____________________ Other _____________________ ______________________ Other ______________________ Other _____________________ Other _____________________ Solar Solar ______________________ Other ______________________ 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 Applicant: Applicant: Applicant: I Ihereby hereby Applicant: I hereby acknowledge acknowledge Iacknowledge herebythat that acknowledge I Ihave have that Iread read have that this this read I have application application thisread application this and and application state state andthat that state the and the that above above state the above that information information theinformation above isiscorrect information correct is correct and andagree is agree and correct to agree tocomply comply and toagree comply with withto all all with comply requirements requirements all requirements with all requirem contained herein and City of Fortthat Collins and state laws regulating building construction. Applicant: Applicant: Applicant: Applicant: Applicant: Applicant: Applicant: III hereby hereby Icontained Ihereby hereby hereby IIacknowledge hereby acknowledge hereby I City hereby acknowledge acknowledge acknowledge acknowledge acknowledge acknowledge that that that I IIhave have Ithat that Iordinances have have have that read Iread Ihave have Iordinances read read have read this this read this read this application this read application application this application this application this application application application and and and and state and state state and and state state and that state that state that that state the that the the that above that the the that above above the above the above the information above above information above information information information information information information isconstruction. correct is is correct iscorrect isis and correct correct correct and and and agree and agree and agree and agree and agree toagree agree comply to agree to tocomply comply to comply to to comply to comply with comply comply with with allwith requirements with all with all with requirements all requirements requirements all allall requirements requirements requirements requirements Applicant: hereby acknowledge that have read this application and state that the above information isiscorrect correct and agree to comply with all requirements contained contained contained herein herein herein and and City and herein ofof City Fort Fort and of Collins Collins Fort City ordinances of ordinances Fort Collins and and ordinances state state and laws laws state and regulating regulating laws state regulating laws building building regulating building construction. construction. building construction. Applicant: I herein hereby acknowledge that I Collins have read this application and state that the above information is correct and agree to comply with all requirements contained contained contained contained contained contained contained herein herein herein herein and and herein herein herein and and and City City City and City and City of and of Fort of City Fort of City of City Fort Fort Collins of Collins of of Fort Collins Fort Collins Fort ordinances Collins Collins ordinances Collins ordinances ordinances ordinances ordinances ordinances ordinances and and and and state and state state and and state state and laws laws state state laws laws state laws regulating regulating laws regulating laws regulating laws regulating regulating regulating regulating building building building building building building building construction. building construction. construction. construction. construction. construction. construction. construction. contained herein and City of Fort Collins ordinances and state laws regulating building construction. contained herein and City of Fort Collins ordinances and state laws regulating building construction. Applicant Signature___________________________________ Print Name___________________________ Phone __________________ Applicant Applicant Applicant Signature___________________________________ Signature___________________________________ Applicant Signature___________________________________ Signature___________________________________ Print PrintName___________________________ Print Name___________________________ Name___________________________ Print Name___________________________ Phone Phone Phone __________________ __________________ _________________ Phone ___________ Applicant Applicant Applicant Applicant Applicant Applicant Applicant Signature___________________________________ Signature___________________________________ Signature___________________________________ Signature___________________________________ Signature___________________________________ Signature___________________________________ Signature___________________________________ Signature___________________________________ Print Print Print Print Print Name___________________________ Print Name___________________________ Print Name___________________________ Print Name___________________________ Name___________________________ Name___________________________ Name___________________________ Name___________________________ Phone Phone Phone Phone Phone Phone __________________ Phone Phone __________________ __________________ __________________ __________________ __________________ __________________ __________________ Applicant Signature___________________________________ Print Name___________________________ Phone __________________ Applicant Signature___________________________________ Print Name___________________________ Phone __________________ Distribution: White – Office Yellow – Applicant Pink – WWW/Stormwater Distribution: Distribution: Distribution: Distribution: White White– White –Office Office – White Office Yellow Yellow – Office Yellow ––Applicant Applicant –Yellow Applicant –Pink Pink Applicant ––Pink WWW/Stormwater WWW/Stormwater – WWW/Stormwater Pink – WWW/Stormwater Distribution: Distribution: Distribution: Distribution: Distribution: Distribution: Distribution: Distribution: White White White White White –White – White Office Office ––Office Office Office ––Office –Office Yellow Office Yellow Yellow Yellow Yellow –Yellow Yellow Applicant – Yellow Applicant –Applicant Applicant ––Applicant –Applicant Applicant Pink Pink Pink Pink –Pink WWW/Stormwater Pink –– Pink –Pink WWW/Stormwater WWW/Stormwater – WWW/Stormwater – WWW/Stormwater –WWW/Stormwater –WWW/Stormwater WWW/Stormwater Distribution: White ––White Office Yellow –––Applicant Applicant Pink WWW/Stormwater Distribution: White – Office Yellow – Applicant Pink – WWW/Stormwater THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE
© Copyright 2025 Paperzz