HomeMy WebLinkAbout124 W Magnolia St - Applications/Other - 03/15/2011City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER 100 5-1 41'D APPLICATION DATE d ^ 13 — / D
Job Site Address
E
Unit #
PROPERTY OWNER INFO: (All owner information is required — it is not optional) Phone # ,1 -10
Last name /A/t-n First Name - Middle
Yt. / 1r Street Address � + Cit � ® $ State�� Zip
CONTRACTOR INFO: Company Name �[� �� Contractor Phone #
Lic Holder Name
Mailing Address_
LEGAL INFO:
Subdivision/PUD
City of Fort Collins License #.
City
Filing # Lot #.
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft Comm'I Sq Ft # of Stories
15' Floor Sq Ft
2nd Floor Sq Ft
3rd Floor Sq Ft
Supervisor Cert #
State Zip
Block # Lot Sq Ft
Total Garage Sq Ft
Bldg Height # Dwelling Units
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths '/2 Baths # of Fireplaces
Air Conditioning: Yes No Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
List appropriate option #s
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) $ zoey-
Description of Work: � F,Q,{,fJ-� f/ r C w.Cjy
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Solar
Roofing
Other
Mechanical
Concrete
Other
Plumbing
Fireplace
Other
Applicant: I hereby acknowl ge that I h ead t is application and state that the above information is correct and agree to comply with all requirements
contained herein and City o ort Collin ordinance and state laws regulating building construction.
'12Applicant Signature Print Name Phone "'7r
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE
City of Planning, Development and Transportation
Fort Collins PO Box 580
281 N College Ave
Ft Collins, CO 80524
970-221-6760 phone 970-224-6134fax
Commercial Construction Application Information
Revised 03/30/2009
Application Number: 6 / /)y 5/�1g,
Job Site Address:
New Building
Building owner: J
Building owner address:
Addition
Building owner phone #: 1 1� - !
Name of Business:
4+ .
Remodel/TF
Proposed Use: (i.e. medical, office, bank, retail, etc)•?�
Project square footage:
For commercial remodels Et tenant finishes, please answer the following questions:
➢ Is the rem e�ftenant is
for an (please circle answer)
existing tenant or new tenant?
➢ If for a new tenant, is this the first tenant to occupy this space? Yes or No
➢ If not the initial tenant for this unit, what was the previous use of this tenant
Space?
➢ Are there any exterior building changes associated with the work?
If yes, please describe:
Sign ure of applic nt
ik a 6�mL
Nana (please print
_.
Date
Yes or No
Local daytime phone #