HomeMy WebLinkAbout3737 Benthaven St - Permits/Electrical - 03/02/1986P.O. Box 580
Fort Collins, CO 80522
CITY OF FORT COLLINS
NOTICE OF BUILDING PERMIT APPLICATION
Building Address
PROPERTY
Subdivision or P.U.D. Filing No.
Lot NO. Block No.
LEGAL
/j
DESCRIPTION
/ •: _ - %+. -
Lot Area
Corner Lot:
Total Street Frontage (lineal feet)
Yes (No
Name
Phone
CONTRACTOR
�t C T C ♦: ' . .,
„J _' . '.�%<'
Address a / City State Zip Code
Name
Phone
OWNER
Address City State Zip Code
2 ❑
Single Family Commercial Number of Units:
USE OF
BUILDING
Multi -Family ❑ Other:
TYPE OF
Gas 0 Electric ❑ Heat Pump ❑ Baseboard ❑ Radiant ❑ Other:
HEAT
WATER AND
Water Tap Size:
�.
f�
❑ 10
SEWER
Sewer Tap Size:
Metered Flat Rate
Drainage Basin
Gross Area
r
STORMWATER
Base Rate 4-•
Coefficient ..
petenti
n Reduction Factor
Floodplain
UTILITY
ZRtthdff
"I I..
Yes No ,
fro be
Utility Fund Nu bar eT AT In 1"42?RM!
R
ainage Basin Fee
completed,
f`'
by others)
Stormwater Uti ity Signa u " tQ oA
,
SSGONOARY
rE
D£SitoNATtO {Y
NOTE:
I understand that the Storm Drainage Basin Fee must be paid prior to the issuance of a Cer-
tificate of Occupancy. I further understand that if drainage improvements are required for
this site, two (2) copies of a drainage report and a drainage plan, signed and stamped by a
APPLICANT
Colorado -registered Professional Engineer, must be submitted to the Stormwater Utility for
approval before a Certificate of Occupancy will be issued.
/
Signature of Applicant: �^
Date:
DISTRIBUTION 1. Original: Applicant — 2. White: Building Inspection — 3. Gold: Stormwater Utility — 4. Blue: Transportation Utility
11 — 5. Pink: Light & Power — 6. Yellow: Water & Sewer