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City of Fort Collins
BUILDING
INSPECTION DIVISION
APPLICATION FOR BUILDING PERMIT AND
CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only.
— CLASS OF WORK —
Press firmly using ball point pen.
New Alteration Addition Demolish Move
Job Address 1" T J _ , �,(..,- _
b ❑ ❑ ❑ ❑
Plbg. Mech. Elea Struct. Fire Prot.
Name ;, > :s`,
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Mail Address _,
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Occ. Gr. 2, .,,'.
.,.
Type Const.,f _. tJ
Use Zone '1::
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Use of Building
Floor Area
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Height i
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Phone'
No. Stories gy{,
Lot Area i ��/ '
Frontage ' r-
Name
Occ. load -
Oce. Change from
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AddressT� . --
Plat File9Jo: L
No. D.U.
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Garage &ba
Fin. Bsmt, area
License No. '"•
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Phone <
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Type heat
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No. Fireplaces or stoves
Lot 'Block
Filing Number F;
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—RELEASES — Dates
Subdivision 4
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PUD ''•
Zoning,:," -
Engineering �;..
DESCRIPTION OF WORK
Fire Department
i
stock Options
'Ian No. Codes
st. Total Cost ( , C =
including labor, material, profit)
1 hereby acknowledge that I have read this application and
;late that the above is correct and agree to comply with all city
)rdmances and state laws regulating building construction.
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Ong,nal-APPl., nW:
Electric Department
Water & Sewer
Plan Review
Special Conditions:
--
Valuation ('i'(, l> _
Plan Check _
Permit
Parkland
City Sales Tax
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage _
Electric Underground
it F
I�sp
FEES
F
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Off -Street Parking
(No. Cars)
Interior Lot ❑
Corner Lot ❑
Reversed Corner Lot ❑
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TOIL 18.25
APt�.JS'E4
ZBA Case # Date
BBA Case # Date
Building Insp. j?,t Approval
by
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Permit.No.
Date -
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