HomeMy WebLinkAbout1909 Mesaview Ln - Applications/Basement Finish - 12/27/2018City of
Frt Collins
ON NUMBER:
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
II ' H It 11 f-L f/ FOR OFFICE USE
APPLICATION DATE:
QA
Job Site Address �aIoR 1MecA 0te&3 F� Wl 61/1µS OU,5o�b Unit#
PROPERTY OWNER INFO: (All\ owner information is required — NOT optional)
Last Name 5 �U S First Name 6�)6� Middle
Street Address ILI 69 A4eSc L/ff6 J (LA City 4 ry 1.I111 S State ' Zip
Phone # ci-7o —9 (7 -7 7 0 P• Email ��� � m c&&5, 0A&A
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name j4MkX L ()LLADK-Q C —
License Holder Name
LEGAL INFO:
Subdivision/PUD
LIC # CERT #
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) Total Garage Sq. Ft.
Residential Sq Ft 6 L) .Lb Commercial Sq Ft __C)_# of StoriesBldg Ht /�# of Dwelling Units
1st Floor Sq Ft 15 Iq 2nd Floor Sq Ft3rd Floor Sq Ft Unfinished Basement Sq Ft / /Z
Finished Basement Sq Ft .S e(o # of Bedrooms # of Full Baths 2
Baths % Baths / # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) K
Air Conditioning? YES ❑
$PA(Simulated Performance ❑
Alternative)
NO 0,
City of Fort Collins Approved Stock Plan # SPO
Prescriptive❑ ERI(Energy Rating Index) ❑
List Option #s
UTILITIES INFO: Gas 101'� Electric E Electric Temp. Pedestal
Electric Main Breaker Size (Residential Only): 150 amp or less ❑
ZONING INFO: (COMMERCIAL USE ONLY)
Proposed Use: (i.e. medical, office, bank, retail, etc.)
Yes ❑ No
200 Amp 0'— Other ❑
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:
s•. .
„ a
Value of Construction (materials and labor): $ I gL
Description of Work: '] t t 5 (ti 5rj (&14 6-P 64 ,'>eAX t,1- '661 tooK ,
bp-/
JOBSITE SUPERVISOR CONTACT INFO: Name C-044-e.(- _ Phone Ow pt� 757-PK
SUBCONTRACTOR INFO: Electrical AryI, kcre Ckc4rte, Mechanical Ge J5 Hea:y' A;r-
Plumbing AfroW mar] SVS Framing MrM t paws(' 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).
4 1 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 W}� Type or Print Name '�6,2)UVl 5�,(-tlyS
Phone# (�-oil�-�%®'o` Email 1Qn>Crbi 0 Aor0 POO'* Ica . LO-AA
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE