HomeMy WebLinkAbout3319 Green Lake Dr - Applications/Single Family New - 08/22/2019 (2)Cityo
Collins
NUMBER:
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave- • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.feaovwm/buildine
BU
Job Site Address 3311 (im
PROPERTY OWNER INFO: (All owner
Last Name
Street Address 3ojg Kwtr ,
Phone # q
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name
License Holder Name C.G'A
LEGAL INFO.
Subdivision/PUD
CONSTRUCfON INFO: Total Building Sq
Residential Sq Ft I 3 Commercial
1st Floor Sq Ft 3 2nd Floor Sq Ft
Finished Basement Sq Ft
% Baths % Baths
ENERGY INFORMATION: (CHECK ONE) _
ComCheck ❑ UA (ResCheck) ❑
PERMIT APPLICATION
APPLICATION
o i? *
Is required — NOT optional)
First Name C,$j0,j Middle
�. LGI I / 1
unit# .;xk LUAIQt W)
_0TCity, W owle State 60 zip ffQ6Z7
CQ Email 41 a° i xrLA4. Cev&
a
LIC# !� ^13:7CERT#307j-CZ
_Filing # _Lot # Block # Z Lot Sq Ft
t (NOT Including basement)1,fjLf 3 Total Garage Sq. Ft.$ .
I Ft .,-- # of Stories_2Bldg Ht # of Dwelling Units,
-<50 3rd Floor Sq Ft :_Unfinished Basement Sq Ft
# of Bedrooms 3 # of Full Baths ,
# Fireplaces
Air Conditioning? YES NO I ❑
City of Fort Collins Approved Stock Plan
UTILITIES INFO: Gas A
Electric Main Breaker Size (Residential
Proposed Use: (i.e. medical, office, bank,
Is the remodel/tenant finishes for an ex
Existing Tenant] New
If for a new tenant, is this the first tenai
Yes ❑ No ❑ If not for the
Performance
Prescriptive❑ ERI(Energy Rating Index) ❑
iAEleC:tr1c
ListOption #STemp. Pedestal Yes ❑ No jR.
150 amp or less 1 , 200 Amp ❑ Other E3
etc.)
or new tenant? (Please check one)
occupy this space?
I tenant for this unit, what was the previous use of this tenant space?
Are there any exterior building changes (I cluding mechanical) associated with the work? Yes ❑ No ❑
If yes, please describe:
Value of Construction (materials and labor):
Description of Work: m Q%AJ
916
a(
JOBSITE SUPERVISOR CONTACT INFO: Name AS-141% Z" a-;% Phone CPO
SUBCONTRACTOR INFO: Electrical [hl ILOPj Mechanical rGj- &
Plumbing • �, 5 Framing Roofing- rA
Fireplace Solar
Other
ASBESTOS STATEMENT DISCLOSURE: In accordance with the State of Colorado Senate Bill 13-152 roe owners, applying for a
remodel permit shall Indicate their awareness about their property having been inspected forAsbestas 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 nducted on this property.
Applicant: I hereby acknowledge at have r d this application and state that the above Information Is correct and agree to
comply with all requireme co I d her nd CI of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature Type or Print Nam cu,
Phone # &P Email %O
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE ^