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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.
Press firmly using ball point pen.
Job Address%li'�. t
Name.
c
Mail Address
3
0
f-
Phone
Name
ro
Address
U
License No.
Phone
°
n
Lot,j
Block
Filing Number
Subdivision fj }
PUD
Parcel #tw-
DESCRIPTION OF WORK
fip l
1f s fs ;3iA • iick ;rEi
Stock Options
Plan No. Codes
Est. Total Costi •F� l
(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 and state laws regulating building construction.
signed,---., --- 1, ddte -
X
— CLASS OF WORK —
New Alteratio k" Addition Demolish Move
❑ P ove., ❑ ❑ ❑
PIbg. Mech. Elec. Struct. Fire Prot.
o ❑ ❑ ❑ ❑
Occ. Gr.
Type Const.
Use Zone
ra ,
Use of Building
Floor Area
Height A
No. Stories
Lot Area ,
F onftage r
Occ. load .
Occ. Change from J_
Plat File No
Garage area
F)n jBsmt. area
Type heat g
No. Fireplaces or stoves
— RELEASES — Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation'` '" FEES
Plan Check `
Permit
Parkland
City Sales Tax
1 d j
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
Total -Fees i' - •,""" �.
Distribution: Original - APPIicant;.Blue - (3ffice,.Canar,Y- Sales•Tax�Eink - A PtiinBld9 Insp. cat; Tag-
Off -Street Parking
(No. Cars)
Interior Lot
❑
Corner Lot
❑
Reversed Corner Lot
❑
a
r
`m
a�
U)
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to
0
i
Street
At
c
ZBA Case #
Date
BBA Case # x #
Date
Building Insp. 3 ?` -;"f Approval
by .. date
0�
Date