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City of Fort Collins BUILDING INSPECTIO
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCU
Applicant complete this part of fotm only.
Press firmly using ball point pen.
Job Address ' '�i �,, BL- { Jr-. MG'" .
Name tn._ t.�•Y,..._ ..,.`�
6
c
Mail Address a � y" ;F ,4e,. 0Aa-Kar..
3
Phone
Name`` ( !}
o
Address
oA
License No.:-�('s
Phone
c
Lot
Block
Filing Number
a
6
Subdivision
PUD
m
v
J
DESCRIPTION OF WORK
d d- / PP ..✓
Stock Options
Plan No. J / Codes
7
Est Total Cost `•"-"�
tincluding labor, mate' iaf; pfo(8)
I hereby acknowledge that I have read this application and
state'tFiat the above is correct and agree to comply with all city
'state
ordinances and laws regulating building construction.
signed t _ .^ %date '
— CLASS OF WORK —
New Alteration Addition
❑ ❑ ❑
Demolish Move
❑ ❑
Plbg. Mech. Elec.
❑ ❑ ❑
Struct. Fire Prot,
❑ ❑
Occ. Gr. Type Const.
Use Zone
Use of Building
Floor Area
Height
No. Stories
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
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation
Plan Check
.FEES.
_
Permit
Parkland
City Sales Tax .-
!Lf f�o1,
St. Oversizing
_
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
I-Total.�ea,s
O
ro
PrifT$
3. a-�c,
TLtTL
?.CEO
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t NCIr
M236:17
10,37 A
APR.03'84
ZBA Case #
Date
SBA Case #
Date
Building Insp.,
Approval
by
date
! ��3
Ll
3- kll I
Permit N
t
Date
no
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