HomeMy WebLinkAbout3200 Gunnison Dr - Applications/Addition or Alteration - 07/19/2019�t of
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
FOR OFFICE USE
APPLICATION NUMBER: " Val �% APPLICATION DATE:
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Job Site Address _12 p p C ormN', saw 1y Unit#
PROPERTY OWNER INFO: (All owner information is required — NOT optional)
Last Name First Namejd��,e ��;� Middle
Street Address �qy'3 pve. City irk (,o \v\S State Cy Zip &DO(p
Phone Ono 9 lctK Email o rr e . -\ d@ C)>-A
Name of Business (COMMERCIAL. USE ONLY) \�C_- A �� + AZA
CONTRACTOR INFO: Company Name ao rs cs"z)
License Holder Name LIC # CERT #
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (NOT including basement) 02 �� (� Total Garage Sq. Ft. 1(�7
Residential Sq Ft 3v Cp3 Commercial Sq Ft # of Stories Bldg Ht # of Dwelling Units
1st Floor Sq Ft 2nd Floor Sq Ft i S �(. S'3rd Floor Sq Ft Unfinished Basement Sq Ft
Finished Basement Sq Ft -# of Bedrooms `( .# of Full Baths
% Baths % Baths \ # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑ SPA (Simulated Performance ❑ prescriptive❑ ERI(Energy Rating Index) ❑
Alternative)
Air Conditioning? YES )' NO ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas ET'� Electric l?'Ilectric Temp. Pedestal Yes ❑ No ❑
Electric Main Breaker Size (Residential Only): 150 amp or less ❑ 200 Amp ❑ Other ❑
ZONING INFO: (COMMERCIAL USE ONLY)
Proposed Use: (i.e. medical, office, bank, retail, etc.) Sr_5 id'<�.rAtie \
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:
Value of Construction (materials and labor):
Description of Work:
JOBSITE SUPERVISOR CONTACT INFO: Name A( & I2j,- -,\ Phone !1?6- qt9- Ida )
SUBCONTRACTOR INFO:
Electrical AID ek4e kit cAe,A-y�ccj Mechanical
Plumbing LLC Framing
Fireplace Solar
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 for Asbestos 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 requiremen contai ed herein and City of Fort Collins ordinances and state laws regulating building construction.
Applicant Signatur Type or Print Name, // Gl'
II-- .r
Phone# q-]o- ,S -QIIS� Email G6nrnle •�lVra.@G',n�c_,l. C-a'-A
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE