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" Clty Of Fort Collins BUILDING INSPECTION DIVISION
-APPLICATION FOR BUILDING PERMJT AND CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only.
Press firmly using ball point pen.
Job Address
Name (y t'.r't! E �f. 66.v.; l ./i"l G
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Mail Address �ti371ri.,ar rJLl' y/r,��'
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Phone✓�[/"3�11fJ
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Name,
Address*
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License No. f j — it F�-ry
Phone
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Lot
Block
Filing Number
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Subdivision t�/LL [✓;+J jf},.�.+
PUD
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Parcel #
DESCRIPTION OF WORK
Stock Options
Plan No. Codes
Est. Total Cost
(including labor, material, profit)
I hereby acknowledge that I have read this application and
state that the above is correct and agree to comply with all city
ordinances a/•nd,,{s/late //laws regulating building cons/tl,occttiion.
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— CLASS OF WORK —
Nne j Alteration Addition Demolish Move
�tiLL ❑ ❑ ❑ ❑
Plbg. Mach. Elec, Struct. Fire Prot.
❑ ❑ ❑ ❑ ❑
Occ. Gr.
Type Const.
Use Zone
Use of Building
Floor Area
Height
No. Stories
Lot Area
Frontage
Occ. load
Occ. Change from
Plat File No.
No. D.U.
Garage area
Fin. Bsmt. area
Type heat
No. Fireplaces or stoves
— RELEASES — Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation FEES
Plan Check
Permit
,o..•-'.:i+/ (� _ ...
Parkland
City Sales Tax
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
otaI F,,a� 1` ---i
-
Off -Street Parking
(No. Cars)
Interior Lot
❑
Corner Lot
❑
Reversed Corner Lot ❑
D
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1
in
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in
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Street
n'tr r i
ZBA Case #
Date
SBACase# ,} r
Date
Building Insp. ( Approval
by \„A date
erg N Flo.
Date
Distribution, Original -Apphcanl: Blue OHice, Oan01y''-Sales Tar; ➢arO Applicant'. '�91dg.lnsp.