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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 2Qt;fl Cilfmlad Lav
Name ti t [ka nn:
c
Mail Address r n a.:
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O
_6 _..____ ..._
Ft. Collitw CD 80526
Phone 99 1-140 In
Name
Address 1005 ti!irrormere Ci.
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? C i'na li Rnl K
License No. C-8 ..C-23 Phone 04-9352.
Lot 17
Block 2
Filing Number
_N
Subdivision
al
PUD _
-Z L
DESCRIPTION OF WORK
`lee Construction
P`
Stock Options
Plan No. ,,�Codes =� -
Est. Total Cost � /.�' __,•.
(including labor, materla�oht)
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.
sicjned vdate
— CLASS OF WORK —
New Alteration Addition Demolish Move
.GC ❑ ❑ ❑ ❑
Pfbg. Mech. Elea Struct. Fire Prot.
❑ ❑ ❑ ❑ ❑
Occ. Gr. Type Const. n'� Use Zone [ea
Use of Building Single ramil
Floor Area 1202
1 Height 270
No. Stories
Lot Area 171r,
Frontage 75
Occ. load
Occ. Change from
Plat File No.
No. D.U. 1
Garage area 288 Bf
Fin. Bsmt. area —(—
Type heat IIleCt P'1.0
No. Fireplaces or stoves I
— RELEASES — Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation - FEES
Plan Check f=-.:r„
Permit `r `r'"--�•^-
Parkland
City Sales Tax
/
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
2_
Electric Underground
%��! .y el-r-)
Total Fees ,---�,-^--�_
Distribution Original Applicant. Blue - di ce: Canary - Sales Tax. Pink - A PPIlca6f. Ta9:Bldg InsP
Off -Street Parking 2
(No. Gars)
Interior Lot
.❑
Corner Lot
❑
Reversed Corner Lot ❑
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Street CiYaalacl { asE` 625.00
TA%PM 624,52
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N21360
jl9:47 A
OCT.07'85
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ZBA Case N
Date
BBACase4 A
Date
Building Insp. j - `
by
'Approval
Permit No. -�
Date
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