HomeMy WebLinkAbout1120 Lake Pl E - Applications/Addition or Alteration - 01/18/2019i
City of
Flirt Collins
CO MLINITY DEVELOPMENT & NEIGHBORHOOD SERVICES
28ZN. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
/% 1 FOR OFFICE USE
APPLICATION NUMBER: 51IM46C1 APPLICATION DATE:
Job Site Address U0 E� L-AVI: PL- f30524 Unit#
PROPERTY OWNER INFO: (All owner information is required — NOT optional)
Last Name IIK1 C 15exop First Name )4en) Middle
Street Address Lq.yx pOL City; tJe7 &—UdAIS State CO Zip 0
Phone# -� OHO Email k e,)sbcad (9avtJ ao k,C60)
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name Homey jiyEg
License Holder Name LIC # CERT #
LEGAL INFO:
Subdivision/PUD
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (NOT including basement)
Residential Sq Ft go Commercial Sq Ft # of Stories
1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft
Finished Basement Sq Ft (,22 # of Bedrooms
% Baths I Yz Baths # Fireplaces
ENGERGY INFORMATION: (CHECK ONE)
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 ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas ❑ Electric ❑ Electric Temp. Pedestal
Electric Main Breaker Size (Residential Only): 150 amp or less ❑
ZONING INFO: (COMMERCIAL USE ONLY)
ERI(Energy Rating Index) ❑
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:
Value of Construction (materials and labor): $ �_
Description of Work:
JOBSITE SUPERVISOR CONTACT INFO: Name
SUBCONTRACTOR INFO: Electrical
Plumbing
Fireplace
Framing
Solar
WIN / =4 PM1 1
Phone
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 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 KCH 61-56,eo rj
Phone # —Email crsb�cz!lor> k. cow
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE