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ty of Fort Collins BUILDING INSPECTION DIVISION
APPLICATION FOR BUILDING ``P.ERWT AND CERTIFICATE OF OCCUPANCY
I Applicant complete this part of form only.
Press firmly using ball point pen.
,lob Address (D
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Mail Address"s> V
1 ,li F.x.,vQ CgiC7
Phone?'✓,��,
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Name
@
_
Address
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License No.
t
!�r Phone "
ILot
Block
Filing Number
nSubdivision
-
PUD
DESCRIPTION OF WORK
i�
Stock 1 Options
Plan Nb. Codes
Est Total Cost ! - r 1
tincluding labor, material, profit)
I lereby acknowledge that 1 have read this application and
state t at,the.above is correct and agree to comply with all city
ordina ces and state laws,regulating building construction.
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— CLASS OF WORK —
New Alteration Addition Demolish Move
❑ ❑ ❑ ❑ ❑
Ptbg. Mach. Elec. Struct. Fire Prot.
❑ ❑ ❑ ❑ ❑
Occ. Gr.
Type Const.
Use Zone
Use of Building
Floor Area Height
No. Stories -
Occ. load
Lot Area Frontage
Occ. Change from
Plat File No.
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 } , •_3 FEES
Plan Check
Permit
Parkland
City Sales Tax t,
_
St. Oversizing
Water plant Investment
_
Sewer Plant Investment
Storm Drainage
Electric Underground
Total'Fees,
_
Off -Street Parking
(No. Cars)
Interior Lot
❑
Corner Lot
❑
Reversed Corner Lot ❑
_IIf(rfD
`m
I�
( 1
0
..JLL
Street
TAXPU +.1.15
T+7TL 34.97
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R259E4
122-15 A
MAY, 30'04
a
ZBA Case h
Date
BBA Case K
Date
Building Insp., 1
Approval
'
by
date r:
DislnbWonl ongnlal - AppLcant, Blue 'Otlicel Canary - Sales Tax Pork = ApphranL Tag - Bldg A" J