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City2�Jof Fort Collins BUILDING NS EC�TION DIVISION� 4 u v v
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only.
Press firmly using ball point pen.
Job Address CMG
Name ; y
a
c
Mail Address
O
Phone211
F-.
Name ~' ' =
AT
iAddress
License No.
1
Phone i
C
a
Lot
Block
Filing Number
N
-
Subdivision
PUD
DESCRIPTION OF WORK
r.
- ]1
Stock Options
Plan No. Codes
Est. Total Cost ' A' -, - `�--
(including -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
— CLASS OF WORK —
New Alteration Addition Demolish Move
❑ . ❑ .'O ❑ ❑
Plbg. Mech. Elec. Struct. Fire Prot.
Occ. Gr. i ._
Type Const. 7 a�
Use Zone
Use of Building
Floor Area ,F -7
Height
No. Stories d
Lot Area
Frontage
Occ. load
Occ. Change from
Plat File No.
No. D.U.
Garage area
Fin. Bsmt. area
Type heat
No. Fireplaces or stoves
— RELEASES — Dates
Zoning r l� :; -7 if
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions
Valuation.4f t t - FEES
Plan Check `.,;
, f ;:,)—
Permit A
1? 7, 0-15"
Parkland
City Sales Tax 171
St. Oversizing f� II IVA,-
i
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
Total Fees
Distribution: Originnl -Applicant; BlueN Office: Canary - Sales Tai: Pinih -Applicant: .i�Idg. Insp.
Off -Street Parking
(No.
Cars)
Interior Lot
O
Corner Lot
❑
Reversed Corner Lot
❑
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ZBA Case it
Date
BBA Case #
Date
Building Insp.Approval
by
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—7 UUN
Permit No.,) _
Date
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