HomeMy WebLinkAbout2636 Somerville Dr - Permits - 07/16/1986City of Fort Collins BUILDING INSPECTION DIVISION
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only.
Press firmly using ball point pen.
Job Address M"L)i ILO
Name
m
C
Mail Address
3
O
Phone
`o
Name
u
Address
c
0
U
Lpense No.
Phone -
C
°
a
Lbt
Block
Filing Number
y
Subdivision
N
PUD
m
Parcel #
DESCRIPTION OF WORK
4
f
6
Stock Options
Plan No. Codes
Est. Total Cost-- —
(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 r - date
— CLASS OF WORK —
New Alteration Addition Demolish
❑ ❑ ❑ ❑
Move
❑
Plbg. Mach. Elec. Struct.
❑ ❑ ❑ ❑
Fire Prot.
❑
Occ. Gr. Type Const.
Use Zone
Use of Building
Height
EFloorAreal
Stories
Lot Area
Frontage
Occ. load Occ. Change from
No. No. D.U.
area
E
EJ
Fin. Bsmt. area
Type heat
No. Fireplaces or stoves
— RELEASES —
Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation FEES
Plan Check
Permit
Parkland
_
_
City Sales Tax
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
Total Fees
DistributionOriginal - Applicant. Blue. -"Office: Oanary - Sales Tax; Pink - Applicant, Tag - Bldg. Insp.
Off -Street Parking
(No. Cars)
Interior Lot
❑
Corner Lot
❑
Reversed Corner Lot
❑
a
m
r
m`
a�
_IV
^1\
d
n
i
in
C
O
_ J
ii
Street
C
O
a
rZBA Case #
Date
BBA Case #
Date
Building Insp. Approval
by date
71116lz
Permit No.
Date