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Clty of Fort~ Collins BUILDING. INSPECTION DIVISION
APPLICATION FOR
BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
of form only.
n
Applicant complete this' part
Press firmly using ball p pen.
Job Address 3318 tittery Ct' ,.
Name ` ri Trim , Xnc.
@
Mail Address �o �d0$�SC�QQL^i�ry 3
O
/A��00
L"to Collins, CO 80526
Phone 223 5050
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Name Roger $tgss" iss
m
Address a� as above
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License No. D-12
Phone 223-5050
°
Lot 107
Block
Filing Number 2
aSubdivision
1�4AF38I7+Sroug l
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DESCRIPTION OF WORK
Sinalz &Mill IF is F
.r
Stock Options
Plan No. 103 Codes
Est. Total Cost $1o�e00
lincluding 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 date`
— CLASS OF WORK
New Alteration Addition Demolish Move
❑ ❑ ❑ ❑ ❑
Plbg. Mech. Elec. Struct. Fire Prot.
❑ ❑ ❑ ❑ ❑
Occ. Gr. I�,-3
Type Const.
Use ZoneRj„t',..
Use of Building
Floor Area
Height
No. Stories
Lot Area 6746
Frontage
Occ. load.
Occ. Change from
Plat File No. 11 � . 3
No. D.U. }
Garage area
Fin. Bsmt. area
Type heat
No. Fireplaces or stoves
— RELEASES — Dates
Zoning it IV')
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation FEES
Plan Check'
Permit
Parkland
City Sales Taxp�Kt
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
Total Fees
k
..Distribution: Original - Applicant -Blue -Office: Canary -Sales Tax: f, t Applicant: Tag -Bldg. Ins,.
Off -Street Parking
(No. Cars)
Interior Lot
XI
Corner Lot
❑
Reversed Corner Lot
❑
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Street
C41
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ZBA Case #
Date
BBA Case #
Date
Building Insp. Approval
by r date
Permit -No.
Date