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1 y of ort Collins BUILDING INSPECTION DIVISION
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only.
Press firmly using ball point pen.
Job Address
Name'.
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Mail Address �q
Phone.:-_
Name r
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Address
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License No.. f
Phone
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Lot Block �r Filing Number
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Subdivision t"
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PUD
DESCRIPTION OF WORK
Y � 1pT ..
Stock Options
Plan No. Codes
Est. Total Cost
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.
signedy ,. , .,--^ 'r ^. ^T�_ — ' date'•
— CLASS OF WORK —
New Alteration Addition Demolish
❑ ❑ ❑ ❑
Move
❑
Plug. Mech. Elec.
❑ ❑ ❑
Struct.
❑
Fire Prot.
❑
OCC. Gr. .�
Type Const.
Use Zone
Use of Building.
Floor Area
Height
No. Stories
Lot Area /F-11 ffij
Frontage
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Occ. load
Occ. Change from
Plat File No. r/0 Ear _
No. D.U.
Garage area
Fin: Bsmt.
area
Type heat
No. Fireplaces or stoves
— RELEASES —
Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation
Plan Check
FEES
FEES
Permit
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Parkland
-
•
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City Sales Tax:
St. Oversizing
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Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
Total Fees
Distribution: Original -Applicant: Blue `Of{ic`e: ;anary\- Sales Tax�P,�n �- Applican P% Tag-,Bl�dg�l S^ p,�
Off -Street Parking
(No. Cars)
Interior Lot AO
Corner Lot ❑
Reversed Corner Lot ❑
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Street inei
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ZBA Case # Date
BBA
Case # Date
Building Insp. Approval
by
date
Permittf Co-_, ,
�- Date
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