HomeMy WebLinkAbout3313 Green Lake Dr - Applications/Single Family New - 08/29/2019 (4)�.F�ort Collins
NUMBER:
Job Site Address
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • wwW.fteov.com/bulldins
BUILDING PERMIT APPLICATION
APPLICATION DATE: 13,
PROPERTY OWNER INFO: (All owner information Is required -NOT optional)
11
Unit# W Alb6dj
Last Name b(46.11j First Name C£rn
Street Address 31*)Q K%4 We C'Ci Middle �->J
tY W� state C.in Zip f{h,n
Phone #
NO WP 114t Email C0 hxrau4. c4-sm,
Name of Business (COMMERCIAL USE ONLY) j Q,�I j MD ✓Y1
CONTRACTOR INFO• Company Name �✓�
License Holder Name 5-" �0 td S&
ItrYvi'S
LIC#^13--)tCERT#SD$-Q
LEGAL INFO:
Subdivision/PUDLtt,AA Filing # Lot # Block # 2 tot Sq Ft --6M �2.
CONSTRUCTON INFO; Total Building Sq Ft (NOT Including basement) Total Garage Sq. R. 41sy
Residential SqF Ft j�Commercial Sq Ft # of Stories 2 Bldg Ht -454 # of Dwelling Units_
1st Floor Sq Ft _ 4413 2nd Floor Sq Ft ! C60 3rd Floor Sq Ft Unfinished Basement Sq Ft ..�
Finished Basement Sq Ft`# of Bedrooms 3 _# of Full Baths
Baths Ya Baths 1 # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑ 91timeruilated Performanceative) Prescriptive❑
Air Conditioning? YES )91 NO ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas Electric J9 Electric Temp. Pedestal Yes
Electric Main Breaker Size (Residential Only): 150 amp or less 200 Amp
ZONING INFO: (COMMERCIAL USE ONLY)
Proposed Use: (i.e. medical, office, bank, retail, etc.)
For Commercial remodels and tenant -lease answer the following uestions:
Is the remodel/tenant finishes for an existing or new tenant? (Please check one)
Existing Tenant[] New Tenant❑
ERI(Energy Rating Index) ❑
❑ No ,.
❑ Other ❑
If for a new tenant, is this the first tenant to occupy this space?
Yes ❑ No ❑ If not for the initial tenant for this unit, what was the previous use of this tenant space?
Are there any exterior building changes (including mechanical) associated with the work? Yes ❑ No ❑
If yes, please describe:
Value of Construction (materials and labor!
132scriPtIon of Work•
JOBSITE SUPERVISOR CONTACT INFO: Name (R-041% Phone
SUBCONTRACTOR INFO: Electrical �ii_gtl�p�/Gi••r�
q���,, �
Plumbing • P , , Framing Mechanical
tlklz Roofing •
Fireplace Solar
i Other
ASBESTOS STATEMENT DISCLOSURE: In accordance with the State of Colorado Senate Bill 13-1524 property owners, applying for a
remodel permit, sholllndicate their awareness about their property having been Inspected forAsbestos containing Materials (ACM$).
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
Applicant: I hereby
Comply with all regi
on this property.
hive #rd this application and state that the above information Is correct and agree to
her nd Cl2y of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature �tr , «� TT'joe or Pri t Nam
Phone # bvT Email
THIS APPLICATION EXPIRES 1130: DAYS FROM APPLICATIQN DATE