HomeMy WebLinkAbout4200 Table Mountain Pl - Applications/Deck - 09/13/2019s
City of
�F„`rt Collins
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: APPLICATION DATE: 11ll ?j Ila
Job Site Address 12(L2- //� �� , Unit#
PROPERTY OWNER INFO: (All owner information is required — NOT optional)
Last Name mil First Name 1-4qkc Middle
Street Address SA[c.- City e Grj l /fI1 State Zip
Phone # Email (�� N(f ®/tJ�• Cep
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name
License Holder Name �%,,,�.�,,L LIC # D--tl�' CERT # 35 22
LEGAL INFO:
Subdivision/PUD
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement)
Residential Sq Ft 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
Total Garage Sq. Ft.
Bldg Ht # of Dwelling Units
Unfinished Basement Sq Ft
# of Full Baths
ComCheck ❑ UA (ResCheck) ❑ SPA (Simulated Performance ❑ prescriptive❑ ERI(Energy Rating Index) ❑
Alternative)
Air Conditioning? YES ❑ NO [I(L
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 ❑ 200 Amp ❑ Other ❑
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)
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 L,1)-1Y&,N I b Phone "/-C-YZ
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).
❑ 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 Signaturek47— Type or Print Name 04A/ t AA
Phone # 9 ZJ-b-tJd I%2-fir- Email &2kSk1, "-1L-A 2" .tom ✓I -Cr
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE