HomeMy WebLinkAbout3904 Benthaven St - Applications/Electrical - 05/01/1986P.O. BoxCITY OF FORT COLLINS
580 20044
Fort Collins, CO 80522 NOTICE OF BUILDING PERMIT APPLICATION
Building Address
3q0� �3Fj2JT r } r�vErtJ ST
PROPERTY
Subdivision or P.U.D. Filing No.
Lot No. Block No.
LEGAL
DESCRIPTION
�r—n�
t��� SSGyUS S
Lot Area
Corner Lot:
Total Street Frontage (lineal feet)
6gd- i rtq F F
Yes No
-5q, y7 1
Name
Phone
C� 6-6(f)G. CoKJC-
c72�� I�{Q�
CONTRACTOR
Address I City State Zip Code
_713 f90 ind {O C SC J fW M-- CvL(- I K4 co MS-LX
Name
Phone
OWNER
,,,,V `` '� {t 11A
Y [
pa
Address City State Zip Code
3a00 i r-7r CocC c,vs CC
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Single Family L!J Commercial ❑ Number of Units:
USE OF
BUILDING
Multi -Family ❑ Other:
TYPE OF
HEAT
"T^`,'*. - '_ :.7
Gas ® Electric ❑ Heat Pump ❑ Baseboard ❑ Radiant ❑ Other:'
WATER AND
fl
Water Tap Size: �
){ E,�:)c;7�
Sewer Tap Size:
'
Metered,❑P FIatRate �
SEWER
IDrainage
Basin t ,
Gross Area
STORMWATER
Rate
Runoff Coefficient
Detention Reduction Factor
Floodplain
UTILITY
79-7-70. 1
T
0 ` �"
i
0'7
Yes No
(to be
Utility Fund Nu ber
Storm Drai ge Basin Fee i
completed
by *them)�%,ai
{�+ry
.
�CCYt f
t -7
Stormwat rUtility Signature
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 f Occu ancy will be issue .
Signature of Applicant:
Date:
DISTRIBUTION 1• original: Applicant — 2. White: Building Inspection — 3. Gold: Stormwater Utility — 4. Blue: Transportation Utility
— 5. Pink: Light & Power — 6. Yellow: Water & Sewer
P.O. Box 580 L,� CITY OF FORT COLLINS 0e, ;` i
,jj 41
Fort Collins, CO 80522 NOTICE OF BUILDING PERMIT APPLICATION !
Building Address
1! !
7,
PROPERTY
Subdivision or P.U.D.
Filing No.
Lot No.
Block No.
LEGAL
DESCRIPTION
Lot Area
Corner Lot:
Total Street Frontage (lineal feet)
i
Yes No
Name
Phone
CONTRACTOR
Address
City
State
Zip Code
Name
Phone
OWNER
Address
City
State
Zip Code
USE OF
Single Family Elti
Commercial ❑
Number of Units:
BUILDING
❑
Multi -Family
Other:
TYPE OF
HEAT
Gas ❑ Electric ❑
Heat Pump ❑ Baseboard ❑
Radiant ❑
Other:
WATER AND
SEWER
Water Tap Size:
Sewer Tap Size:
Metered ❑
Flat Rate
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
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
— 5. Pink: Light & Power — 6. Yellow: Water & Sewer