HomeMy WebLinkAbout4733 S Timberline Rd - Applications/Tenant Finish - 03/14/2007City of Fort Collins
BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Sox 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER _2APPLICATION DATE
Job Site Address 4133 S Ti Unit #
PROPERTY OWNER INFO: (All owner information is required —it is not optional) Phone # ko2. 4c*i3 •zsob
Last Name DIAIL,- b'(.L'DL.L 11.15-f LLCM First Na
Middle -
Street Address 115Dr(o ti:ti-&Z AS'9r Cityj�State tIE Zip IvtSt5-1
CONTRACTOR INFO: Company Name ` 'C���% (DiIS//c r ,!r /rK. Contractor Phone # '7e'D —6$ 6
Lic. Holder Name Gco,'L City of Fort Collins License # 3 /� Supervisor Cart #
Mailing Address P-49. tE,>Ox ZOO City_4& r; , State CO Zip S-OS SO
LEGAL INFO: AL L- IntM12,1o2 WDl21, tit(r
Subdivision/PUD Filing # Lot # Block # Lot Sq
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) OD Total Garage Sq Ft III
Residential Sq Ft N (ft Comm -I Sq Ft %, 3 o e # of Stories i Bldg Height # Dwelling Units nl
1 st Floor Sq Ft 71�3o V 2nd Floor Sq Ft t_l �•A Unfinished Bsmt Sq Ft M A Finished Bsmt Sq Ft ' IA
# of Bedrooms N / A # of Full Baths — N / % Baths �_ '/2 Baths # of Fireplaces 1�f 1 ft IlkT �
Air Conditioning: Yds No Energy info: (Circle appropriate choice) ComChec 2. ResCheck w1Air Sealing
3. ResCheck w/Blower Door 4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # List appropriate option #s
UTILITIES INFO: 1 �A-t'rZ F I r cmi — tAlk
Water Tap Size Sewer Tap Size Metered: Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential onh
Value of Construction (including labor, material & profit) S 21i4z�C3b"b ��
Description
Contact Name & Phone # of JOBSITE SUPERVISOR:
Temp. Pedestal: Yes or No
❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Ww
Subcontractor Info: Ido-r AVAtI,-A*Lr_ �
Electrical /C'^cme E7em4l4co.( _';r.vpWchanical /`/7�^ lo'w Plumbing CtJccrs'rL plze*4ia41
Framer i%rt,,,x// Roofing /Y//i9 Concrete Other s
Applicant: I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of ort Collins ordinances and state laws regulating building
Ccoon-struccttiion.
Applicant Signature Print Name 4 "1ibYrtil0 Phone72U•q40•9228
Distribution: White - Office Yellow -Applicant Pink- WJVW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE
Community Planning and Environmental Services
Fort Collins Neighborhood & Building Services
CAv or'rorrconins 281 N. College Ave., P.O. Boa 580; Fort Collins, CO 80522-0580; Voice: 970 2216760 FAX: 970 224 6134
BUA701473
Commercial Construction Application Information
Revised March 6, 2006
Application Number:
Job Site Address: A?a3 S I IMeev2LlwlE ab Unit #
New Building Addition Remodel/TF,
Name of Business: GCb Ir4oe'- Ott cbNics
Proposed Use: (i.e. medical, office, bank, retail, etc) 12V► MA L-
Project square footage: 2 ► 4 (P
For commercial remodels and tenant finishes, please answer the following:
e�'Is the remodel/tenant finish for an existing tenant or new
tenant? Klee
&Klf for a new tenant, is this the first tenant to occupy this
space? f-Ap
a"�If not the initial tenant for this unit, what was the previous use of this
tenant space? (If known) -i�)r-ttrA L_
Are there any exterior elevation changes associated with the
work? t-1 o
cix;r _
SicHature
STNG Ci10Vrr4o
Name (Please print)
3- q•
Date
720 . g4-tv. 32.z8
Local daytime phone #