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HomeMy WebLinkAbout3450 Lost Lake Pl - Applications/Basement Finish - 08/09/2019,City of �3� F 8ry Col�InS COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building BUILDING PERMIT APPLICATION 1 FOR OFFICE USE APPLICATION NUMBER: 1 (��G( oZ� APPLICATION DATE: Job Site Address '-� (pie— Unit# PROPERTY OWNER INFO: (All owner information is required — NOT optional) Last Name l First Name Leatx Middle Street Address 34�� L0 LaIIII e—?City G (%t,-5 State Cc Zip VG:C>29 Phone # Lj70 — 7(8 _ C:7 tL Email �k�,,,�� `p �� ,Cep•,—� Name of Business (COMMERCIAL USE ONLY) CONTRACTOR INFO: Company Name �Ina, kg11g AAC License Holder Name gg� c�Ci"``�1� LIC # `�jZ—`(`�CERT # LEGAL INFO: Subdivision/PUD L- 3 Filing # Lot # Block # Lot Sq Ft CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) Residential Sq Ft Commercial Sq Ft # of Stories 1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft Finished Basement Sq Ft �Ip0 -# of Bedrooms ( Baths ( % Baths # Fireplaces ENERGY INFORMATION: (CHECK ONE) ComCheck ❑ UA (ResCheck) ❑ Air Conditioning? YES ❑ $PA(Simulated Performance ❑ Alternative) NO ❑ Total Garage Sq. Ft. Bldg Ht # of Dwelling Units Unfinished Basement Sq Ft 1�i-* # of Full Baths Prescriptive❑ ERI(Energy Rating Index) ❑ City of Fort Collins Approved Stock Plan # SPO List Option #s UTILITIES INFO: Gas Cl Electric ❑ Electric Temp. Pedestal Electric Main Breaker Size (Residential Only): 150 amp or less ❑ ZONING INFO: (COMMERCIAL USE ONLY) Yes ❑ No ❑ 200 Amp ❑ Other ❑ Proposed Use: (i.e. medical, office, bank, retail, etc.) For Commercial remodels and tenant finishes, please answer the following questions: Is the remodel/tenant finishes for an existing or new tenant? (Please check one) Existing Tenant❑ New Tenant❑ If for a new tenant, is this the first tenant to occupy this space? Yes ❑ No ❑ If not for the initial tenant for this unit, what was the previous use of this tenant space? Are there any exterior building changes (including mechanical) associated with the work? Yes ❑ No ❑ If yes, please describe: d� Value of Construction (materials and labor): $ ��- JOBSITE SUPERVISOR CONTACT INFO: Name SUBCONTRACTOR INFO: Electrical Plumbing t �'�r c� Framing Fireplace Solar Phone 1;Q6, Mechanical N,--, _ Roofing Other ASBESTOS STATEMENT DISCLOSURE: In accordance with the State of Colorado Senate Bill 13-152, property owners, applying for a remodel permit, shall indicate their awareness about their property having been inspected forAsbestos Containing Materials (ACM's). ❑ I do not know if an asbestos inspection has been conducted on this property. ❑ An asbestos inspection has been conducted on this property on or about (enter date) ❑ An asbestos inspection has not been conducted on this property. 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 ordinances and state laws regulating building construction. Applicant Signature Type or Print Name — Phone # ©e) Email THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE