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Cl bi T, F IVISION
APPLICATION FOR OU1LDING PERMIT AND CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only.
Press firmly using ball point pen.
Job Address 1673 Shenandooh Circle
Name Medenta Howes, Inc.
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Mail Address
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rt. Collins CO 80525
Phone 226-5531
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Name
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Address SAME
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License No. pp-28
PhonO 226-5531
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Lot 16
1 Block Filing Number 3
Subdivision Golden Meadows
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PUD
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DESCRIPTION OF WORK
Stock 119 Options EB, v, H,
Plan No. Codes_ ,
Est. Total Cost $71, 974. 00
(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 date
— CLASS OF WORK
New Alteration Addition Demolish Move
W- ❑ ❑ ❑ ❑
Plbg. Mach. Elec. Struct. Fire'Prot.
CV -a- - ❑
Occ. Gr.
Type Const. ' ,y
Use Zone
Use of Building
FloorArea ,? f
Height
No. Stories ,Y
Lot Area
Frontage
Occ. load
Occ. Change from
Plat File No.
No. D.U. /
Garage area /y' fi
Fin. Bsmt. area
Type heat
No. Fireplaces or stoves
— RELEASES — Dates
Zoning
Engineering
Fire Department
Electric Department
Water 8 Sewer
Plan Review
Special Conditions:
Valuation I `" i `/ - v0 FEES
Plan Check j Z.
Permit
•O/0,16, • / O
Parkland
:r -.-17 5 0 • Cll
City Sales Tax
TGtq - "
St. Oversizing
y`r 'f (r r,40
Water Plant Investment
Sewer Plant Investment
Storm Drainage
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Electric Underground
! CTv
Total Fees
Fs'
Distribution: Original Apptican,. Blue- office; Canary - Sales Tax; Pink - Applicant; Tag - Bldg. Insp.
Off -Street Parking
(No. Cars)
Interior Lot
p
Corner Lot
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Reversed Corner Lot
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Street
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ZBA Case #
Date
BBA Case #
Date
Building
Insp. Approval
by
date
MAY13
Permit No.
ate