HomeMy WebLinkAbout2037 Langshire Dr - Applications/Addition or Alteration - 12/17/2018j
City of
.,Fort Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
(APPLICATION NUMBER: /I l N 10 V H i/FORUFFlCEUSE APPLICATION DATE:
Job Site Address 2,0?)-7 NC N12E DR, Fie, co gOS2(o Unit#
PROPERTY OWNER INFO: (All owner information is required — NOT optional)
Last Name 90 HpE First Name P L Middle /��\UR_
Street Address 2o37. LAN&5H2F_ D(Z City 1=U(?-7- (0CL'k N S State i✓Q Zip 250S2,o
Phone# C110 2'2-7— la(2g Email P(Z"p'•LANF rzi5 @C�(W�1L_. Com
Name of Business (COMMERCIAL USE ONLY) v
CONTRACTOR INFO: Company Name DvgNC_-Ii�_
License Holder Name LIC # CERT #
LEGALINFO:
Subdivision/PUD (p 1 �SFiling # 10135 Lot #
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) _
Residential Sq Ft o c/ Commercial Sq Ft # of Stories_
1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft
Finished Basement Sq Ft
% Baths % Baths _
ENERGY INFORMATION: (CHECK ONE)
# of Bedrooms
# Fireplaces
_Block # Lot Sq Ft
Total Garage Sq. Ft.
_Bldg Ht # of Dwelling Units
Unfinished Basement Sq Ft
# of Full Baths
ComCheck ❑ UA (ResCheck) ❑ SPA (Simulated Performance ❑ Prescriptive❑
Alternative)
Air Conditioning? YES ❑ NO T
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas P Electric IN Electric Temp. Pedestal Yes
Electric Main Breaker Size (Residential Only): 150 amp or less ❑ 200 Amp
ZONING INFO: (COMMERCIAL USE ONLY)
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)
ERI(Energy Rating Index) ❑
❑ No W
❑ Other ❑
_1_4 ' nt$ 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 IPAvL_ Phone
SUBCONTRACTOR INFO: Electrical
Plumbing
Fireplace
Framing
Solar
Mechanical
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
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 Named
Phone# 110 222 (D 12`6 Email P�P,()J-\'�)F�5- 0—
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE