HomeMy WebLinkAbout2121 Midpoint Dr - Applications/Tenant Finish - 07/02/2009BUILDING PERMITS &INSPECTIONS DIVISION
_+= P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER fkaO✓ 9 APPLICATION DATE
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-'Job Site Address /� / /��l Ge�,� �/ . Unit # A0Z
PROPERTY OWNER INFO:: (All owner information is required — it isnotoptional) Phone #
Last Name /"/a.�-C/ First Name / 151 /1 - L- Middle
Street Address ���� /'� %�sPo�%�� �// City!'�9 ��+"� States// Zip !-
CONTRACTOR INFO: Company Name A C /'T G LGContractor Phone # ,303-y�r� �r3O�
Lic. Holder Name,//i!�! S� City of Fort Collins License # Supervisor Cert #
Mailing Address �,3�� �/, `7�f�' City �EsGxL� State
LEGAL INFO:
Subdivision/PUD
Filing # Lot #.
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft
1st Floor Sq Ft
# of Bedrooms
Air Conditioning: Yes No
3. ResCheck w/Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
Block # Lot Sq Ft.
Total Garage Sq Ft
Comm] Sq Ft # of Stories Bldg Height # Dwelling Units
2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft _
# of Full Baths % Baths '/2 Baths # of Fireplaces
Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
List appropriate option
Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal: Yes or No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only): ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ Z.�2, Od n
Description of Work:
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
_ Electrical Mechanical I --Plumbing
Framer Roofing Concrete Other
Applicant: I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort Collins ordinan and state laws regulating building construction. e
Applicant Signature Print Name �y-e S� /��� T Phone�O
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Distribution: White — Office Yellow — Applicant Pink — WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE
Community Planning and Environmental Services
Building and Zoning Department
City of Fort Collins
Commercial Construction Application Information
Revised May 10, 2000
Application Number:
Job Site Address:A, �,��,.�,>< 4i- Unit # Ja /
New Building Addition Remodel/TF
_Z
Name of Business:
Proposed Use: (i.e. medical, office, bank, retail, etc)�sr�,,
Project square footage: ,-7a'o
For commercial remodels and tenant finishes, please answer the following:
Is the remodel/tenant finish for an existing tenant or new
tenant? 111ai
❑ If for a new tenant, is this the first tenant to occupy this
space? . -
❑ If not the initial tenant for this unit, what was the previous use of this
tenant space? (If known)
❑ Are there any exterior elevation changes associated with the
work?
Describe:
Signature
�c�O
Name (Please print)
-7z-0
Date
Local daytime phone #
281 North College Avenue • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6760 , FAX (970) 224-6134