HomeMy WebLinkAbout1016 Laporte Ave - Applications/Addition or Alteration - 08/30/2019City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6r_t Collins
281 N. College Ave. •Fort Collins, CO 80524 •Phone: 970.416.2740 • www.fceov.com/building
BUILDING PERMIT APPLICATION
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APPLICATION NUMBER: (61-1O SDSI FOR OFFICE USE APPLICATION DATE: T7.15 1 -(
Job Site Address Q �� L CG Po r � V2 I Unit#
PROPERTY OWNER INFO: (All owner information is required — NOT optional)
Last Name PeAc.e_ First Name mG.ry I 00 Middle
Street Address _j (? (G 1 "C(, Po f-4 A,& City T—o r4 C o) («g State Zip 6 05Z It
Phone# 9%0Z1q,•30G6 Email McryIOUs Cl ( QMCL"l./ Co."
Name of Business (COMMERCIAL. USE ONLY)
CONTRACTOR INFO: Company Name
License Holder Name
LEGAL INFO:
LIC # CERT #
Subdivision/PUD CaPI'1 I �`<< <� Filing # Lot # 8 Block # 32Z Lot Sq Ft 8, 25Z-5
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) �, 006 Total Garage Sq. Ft. �l 30
Residential Sq Ft r#of toriesZBlg HtC"#of Dwelling Units r
1st Floor Sq Ft O()0 2nd Floor Sq Ft. 40oo 3rd Floor S,q/Ft ` Unfinished Basement Sq Ft :1�0
Finished Basement Sq Ft 75Q # of Bedrooms # of Full Baths 2
Baths % Baths F2� # Fireplaces rX
ENERGY INFORMATION: (CHECK ONE)
(Simulated Performance
COmCheCk [IUA (ResCheck) El SPA Alternative) ❑ Prescriptive❑ ERI(Energy Rating Index) ❑
Air Conditioning? YES ❑ NO 10
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas ❑ Electric ❑ Electric Temp. Pedestal Yes ❑ No ❑
Electric Main Breaker Size (Residential Only): 150 amp or less E9 200 Amp ❑ Other ❑
ZONING INFO: (COMMERCIAL USE ONLY) /
Proposed Use: (i.e. medical, office, bank, retail, etc.) (/,yam/Z// 14
For Commercial remodels and tenant finishes, please answer the 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 N
If yes, please describe:
6-e7
Value of Construction (materials and labor):
Description of Work:
JOBSITE SUPERVISOR CONTACT INFO: Name Phone
SUBCONTRACTOR INFO: Electrical Mechanical
Plumbing Framing ' Roofing
Fireplace Solar 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).
K 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: 1 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 an ity of Fort Collins ordinances and state laws regulating building construction.
Applicant Signatur Type or Print Name
Phone # ? Q Z{ U S'l a Email M,4 Le V L D (i ETC %} / j_ (�� o >M
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE
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