HomeMy WebLinkAbout814 W Drake Rd - Applications/Tenant Finish - 12/20/2012City of
II COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
�t Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER ?5 / b l6:(o APPLICATION DATE I — Z-0 �1 l
Job Site Address / y U, DrAk L f� _ r ► • G 4/�`,S- C.) Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone # 15170 - 2Z to c
Last name d f�of r 7 / t����� 11 • G s First Name
Middle
Street Address ��3 �. dcti,ll y /U City
State C ) Zip
CONTRACTOR INFO: Comp/any Name (�9r/tcrS�Gvt< �J.�.ay/�r�r�K �econtractor Phone # 1%j . Z /,- ((y 2 (
Lic Holder Name �O Sh1A c e /U City of Fort Collins License #
Supervisor Cert #
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Mailing Address �g� ' �( CityZO Ue &7 ?
State (U Zip OS3J
LEGAL INFO:
Subdivision/PUD Filing # Lot #
Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including ement)
Total Garage Sq Ft
Residential Sq Ft Comm] Sq Ft # of Stories Bldg Height # Dwelling Units
J G
ls' Floor Sq Ft 2n° Floor Sq Ft 31 Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths 3/4 Baths
/z Baths # of Fireplaces
Air Conditioning: Yes No Energy info: ( Circle appropriate choice) 1. ComCheck
2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan # List appropriate option #s
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: Yes or No
Temp. Pedestal Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker (Residential only) ❑ 150
Amp or Less ❑ 200 Amp ❑ Other
//Size
Value of Construction (including labor, material & profit) $�yc)
cription of Work: 9 e, W 0 k; I � 113 /0 S •
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Contact Name & Phone # of JOBSITE SUPERVISOR: C, S ✓,,,S e i D r
Info: 61 20, 1, [,)7C�
i (7 S75"/ - 606 e7
Subcontractor
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Electrical %; - r; /4 Geed r� �dey Mechanical / t/Plumbing
/�•/; � I �QCGA Gir<c+L
r
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Framer Roofing Concrete
Fireplace
Solar Other e_ Other Other
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 Fort C 'ns ordinances_pd state laws regulating building construction.
Applicant Signature ��/ Print Name o2J • ` 4 / � Phone / • `oc)� ^
Distribution: White —Office Yellow —Applicant Pink — WWW/Stormwater
THUS APPLODATOON EXPURES 180 DAYS FROM APPLDOAT00M DATE
Fort Collins
Commercial
Application Number:
Planning, Development and Transportation
PO Box 580
281 N College Ave
Ft Collins, CO 80524
970-221-6760 phone 970-224-6134fax
Construction Application Information
��Revised 03/30/2009
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Job Site Address: <�//q 0 - —D r'�" /—1'cd - �--T- :f 0 t//^ S- C (D o"se
New Building
Building owner:
Building owner address:
Building owner phone #:
Name of Business:
Addition
Remodel/TF
Proposed Use: (i.e. medical, office, bank, retail, etc) e S S
Project square footage:
For commercial remodels & tenant finishes, please answer the following questions:
➢ Is the remodel/tenant finishes for an (ple a circle answer)
existing tenant or ew tenant
➢ If for a new tenant, is this the first tenant to occupy this space? Yes or No
➢ If not the ' itial tenant for this unit, what was the previous use of this tenant
Space? -%,Ae s 5
➢ Are there any exterior building changes associated with the work? Yes or 6o
If yes, please describe:
I �`4 z'
Signature of applicant Date
(,kSer,7�A72�,'e W/".70/( qTo -
Name (please print) Local daytime phone #
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