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City of, .,Fort Colljns BUILDING INSPECTION DIVISION
" APPLICATION FOR BUILDING PERAAIT AND CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only.
Press firmly using ball point pen.
Job Address
Name l -_
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Mail Address ,a r ;G _�
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Phone ?�
Name
Wu
Address -
o
License No.
Phone-
4
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Lot Block
Filing Number
H
Subdivision
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PUD
Parcel #
DESCRIPTION OF�WORK
Stock ��� Options , ,j �..�.
Plan No. Yl/ �cCo�de�s+f�
Est. Total Cost✓-L%. QA
(including labor, material, profit)
I hereby acknowledge that I have read this application and
state that th"
,Pove is correct and agree to comply with all city
ordinanc �ddsstatte laws regulating building const uclion.
signed date
— CLASS OF WORK —
New Alteration Addition Demolish Move
❑ ❑ ❑ ❑
Plb Mech. Elec. Struct. Fire Prot ..
Occ. Gr.-
Type Const_
Use Zone
Use_gOf�uilding
Floeri(rea —?
Height
Lot Area J
Frontage
Occ. load
Occ. Change from
Plat File No. (1 t (Y r
No. D.U. /
Garage area
FT.?_ Cf
Type heat
N Fireplacesy0%ctau4c� /
--RELEASES — Dates
Zoning ,
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
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00
Valuation FEES
Plan Check -• �/. C
d'
Permit
Parkland
City Sales Tax
St. Oversizing
G%C `^
_
Water Plant Investment
Sewer Plant Investment
�•'_ '+ �_
Storm Drainage
-
Electric Underground
Total Fees
Distribution - Original - Applicant. Blue - office. Canary - S \es Fax.Pink - ApplI Ta( -,gIdg Insp.
Off -Street Parking
(No. Cars)
Interior Lot
❑''r
Corner Lot
❑
Reversed Corner Lot
❑
5 >
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ILL
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Street
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ZBA Case #
Date
BBA Case #
Date
Building Insp'.i
Approval
by
date
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Permit No.
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