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City of Fort CollinBUILDING INSPECTION DIVISION p
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APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only.
Press firmly using ball point pen.
Job Address
Name. ,, AA, i. k.,
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Mail Address r`f �
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Phone G� ... ��-�"{/ •�
Name ## ,
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Address i .'i J4': s. ,.•"¢�
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License No.
Phone ,.; <-t'r. 7
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Lot Block Filing Number
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Subdivision
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DESCRIPTION OF WORK
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Stock Options
Plan No. Codes
Est. Total Cost Ar.
lincluding labor, material, profit)
I hereby acknowledge that I have read this application and
state that -the afjove is correct and agree to comply with all city
ordinances and state laws regulating building construction.
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— CLASS OF WORK —
New Alilgration Addition Demolish. Move
❑ 9 ❑ ❑ ❑
Plbg. Mech. Elec. Struct. Fire Prot.
❑ ❑ ❑ ❑ ❑
Occ. Gr.
Type Const.
Use Zone k" _
Use of Building
Floor Area
Height y +�
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
—JRELEASES — Dates
Zoning a' d. /_-
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Reviewyti
Special Conditions:
Valuation FEES
Plan Check
f {
Permit;
Parkland
City Sales Tax
;T c�
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
Total Fees
Distribution: Origin al -A rrfzi),ca In i,' Blue -Of fico': Canary -Sales Tax: Pin -Applicant: Tag-- Bldg:'Insp.
Off -Street Parking
(No. Cars)
Interior Lot ❑
Corner Lot ❑
Reversed Corner Lot ❑
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Street
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ZBA Case # Date
BBA Case # Date
Building
Insp. Approval
by
_ i : date
Permit NnoL—
Date'
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