HomeMy WebLinkAbout723 Locust St - Applications/Addition or Alteration - 08/05/2019City of
F, 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: 51g6&S7-'1 APPLICATION DATE: t 6- 0o
Job Site Address `123 L nC.LL t 2t � { Co(�irns, C - Unit#
PROPERTY OWNER INFO: (All owner information is required - NOT optional)
Last Name First Name
Street Address R0 , �OK, ae-1 City
Phone # LnG�_q Email !WC
-a�
Middle
State CO Zip BDC-22
Name of Business (COMMERCIAL USE ONLY) TW LYl i�1ktQS �1 �U�S�I YLQ 11 �} O
CONTRACTOR INFO: Company Name Stumb
License Holder Name &CU-) L' CLr'-'W LIC # D6L3 CERT # 41`lS-D l
LEGALINFO: E
We OF
Subdivision/PUD I) -) — WeS{ ��, Filing # Lot # Ike Block # Wt1WLot Sq Ft (,L421
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) 2,c?':L2 Total Garage Sq. Ft. '2
Residential Sq Ft �Z�-Commercial Sq Ft O # of StoriesBldg Ht L U' # of Dwelling Units j
1st Floor Sq Ft '2-o42_ 2nd Floor Sq Ft L--".i 3rd Floor Sq Ft O Unfinished Basement Sq Ft 0
Finished Basement Sq Ft L.o OS # of Bedrooms ?1, # of Full Baths
Baths 0 % Baths 0 # Fireplaces 3
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ,21 SPA(Simulated Performance ❑ prescriptive❑ ERI(Energy Rating Index) ❑
Alternative)
Air Conditioning? YES J9 NO ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas EL Electric & Electric Temp. Pedestal Yes ❑ No ❑
Electric Main Breaker Size (Residential Only): 150 amp or less MI 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: NEW C"i:& IG . � Ct YlCISCC_OC' . cu-A V1MR1A'_q
r
Value of Construction (materials and labor):
Description of Work:
JOBSITE SUPERVISOR CONTACT INFO: Name smn Ccu-sm Phone Gn() - U 69 - qq l l
SUBCONTRACTOR INFO: Electrical CgQoea• Conn_ec'Mims Mechanical Caazu0rx P-ltch=(Col
Plumbing Move IRU °I ILLMIOCl 5 Framing COndrLtCl01\. Roofing ��]� �, MoA(-LACU-1,1.
Fireplace S FeT)-z Solar Other n wl
ASBESTOS STATEMENT DISCLOSURE: In accordance with the State of Colorado Senate Bill 13-152, property owners, applying fora
remodel permit, shall indicate their awareness about their property having been inspected forAsbestos Containing Materials (ACM's).
xI 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 ;RqjreL4 tAcw q yc)riL
Phone # SLVLO - U f�lo - 8.31 Email pnY ych R 1 Ylc�u1 EgSfCtf1C%u (1oT1 tQ c . Corn
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE