HomeMy WebLinkAbout1916 Orchard Pl - Applications/Addition or Alteration - 08/01/2019.t
1
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 101 1p
APPLICATION NUMBER: IrV101
,^ I ^(�I,^'/v\ (t I -I I FOR OFFICE USE
J1 APPLICATION DATE: r I
f r
Job Site Address �'
! 0M& Co 1t
PROPERTY OWNER INFO: (All owner information is requl ed —NOT optional)
flaron �capk1 b Celeste wac-f
Last Name First Name L
Street Address M 16 Ord ett Pl o- city T a t (tl A
Phone # 91U-231— 7 _K2, Email ae
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name
License Holder Name
LEGAL INFO:
Subdivision/PUD I ' l wu Filing # Lot #
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) _
Residential Sq Ft 626 Commercial Sq Ft ! #of Stories_
Middle
_State Co Zip V)sz
LIC # CERT #
Block # Lot Sq Ft gS8_3
Total Garage Sq. Ft.�
Bldg Ht # of Dwelling Units
1st Floor Sq Ft t 62G 2nd Floor Sq Ft 3rd Floor Sq Ft Unfinished Basement Sq Ft_
Finished Basement Sq Ft y # of Bedrooms 3 # of Full Baths /
Baths _ %: Baths / # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑ SPA (Simulated Performance
Alternative)
Air Conditioning? YES ❑ NO bd
City of Fort Collins Approved Stock Plan # SPO
❑ Prescriptive❑ ERI(Energy Rating Index) ❑
List Option #s
UTILITIES INFO: Gas 9�, Electric M Electric Temp. Pedestal
Electric Main Breaker Size (Residential Only): 150 amp or less ❑
ZONING INFO: (COMMERCIAL USE ONLY)
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 build
If yes, please describe: 10
tA(A � �
Value of Construction (materials and labor): $
,
Plumbing
Fireplace
PACT INFO: Name U (!dq<tk ` Phone Z
Electrical w- Mechanical bkti Q1rAQ0A'
ru
ing N 144- Roofing
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).
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 N/almee MnL War+
M
Phone # "I t)- 7-�] I,
1 A9 Email /1O.00�O t jYjr-!Gil. Clint AA . G&-Vl
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE