HomeMy WebLinkAbout1812 Birmingham Rd - Correspondence/Other - 05/17/198829083
CITY OF FORT COLLINS
P.O. Box 580
Fort Collins, CO 80522 NOTICE OF BUILDING PERMIT APPLICATION
Building Address
PROPERTY
Subdivision or P.U.D. f Filing No.
Lot No. Block No.
LEGAL
DESCRIPTION
Lot Area
Corner Lot:
Total Street Frontage (lineal feet)
Yes No
Ir
Name
Phone
CONTRACTOR
y
Address City State Zip Code
Name Phone
OWNER
Address City Zip Code
Iry 0009
Single Family ❑
Multi -Family
USE OF
BUILDING
Commercial ❑
State Type of Bu n s F
SEA
EfErto Code Sheet)
TYPE OF
Gas Electric ❑ Heat Pump 1:1 Baseboard 1:1 RadiantEl Other:
HEAT
WATER AND
Water Tap Size:
❑
SEWER
4
Sewer Tap Size:
Metered Flat Rate
Drainage Basin
Gross Area
,STORMWATE . R
Base Rate
Runoff Coefficient
Detention Reduction
Floodplain
Utility Fund Number
UTILITY
Factor
Yes No
(To be
Stormwater Utility Signature
Storm Drainage Basin.Fee.
completed
by others)
STREET
Signature
Date
OVERSIZING
Fee
(To be completed
by others)
Fee to be waived 0
NOTE: I understand that the Storm Drainage Basin Fee must be paid prior to the issuance of a
Certificate of Occupancy. I further understand that if drainage improvements are required for
this site, two (2) copies of a drainage report and a drainage plan, signed and stamped by a
APPLICANT
Colorado -registered Professional Engineer, must be submitted to the Stormwater Utility for
approval before a Certificate of Occupancy will be issued.
Signature of Applicant: J.
Date:
DISTRIBUTION
1. �hinal- �Alic�anl— 2- Gold: Stormwater Utility — 3. Blue: Transportation Utility — 4. Green: Street Oversizing
5. Pink: Light & Power 6. Yellow: Water & Sewer