HomeMy WebLinkAbout2119 Stetson Creek St - Applications/Basement Finish - 09/18/2019City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
�t Collins
281 N. College Ave. •Fort Collins, CO 80524 •Phone: 970.416.2740 • www.fc¢ov.com/building
BUILDING PERMIT APPLICATION
FOR OFFICE USE
APPLICATION NUMBER: 11409 APPLICATION DATE: G/, 111 lot
Job Site Address
owner information is required — NOT optional)
Last NameFirst Name
Street Address 2zl? City
Phone # �7/G�l'�j�Email
Name of Business (COMMERCIAL USE ONLY)
CONTRACTORINFO:
License Holder Name
LEGAL INFO:
Subdivision/PUD
CONSTRUCTON INFO:
Residential Sq Ft
Unit#
A Middle
State,�/j9 zip"�
Company Name e!�7L�90G f�,�1� ,fjy✓�;cT..1i�d
LIC#,V,,&W CERT#
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq. Ft.
Bldg Ht # of Dwelling Units
1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft Unfinished Basement Sq Ft
Finished Basement Sq Ft _� �# of Bedrooms ` # of Full Baths /
% Baths % Baths # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑ SPA(Simulated Performance ❑ prescriptive❑ ERI(Energy Rating Index) ElAlternative)
Air Conditioning? YES NO ❑
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 followinit 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:
Total Building Sq Ft (NOT including basement)
Commercial Sq Ft # of Stories
Value of Construction (materials and labor):. —
Description of Work:
JOBSITE SUPERVISOR CONTACT INFO: Name
SUBCONTRACTOR INFO: Electricall�h,?/-„A�y-. ��MechanicaI
Plumbing ''77``��
Fireplace
Framing
Solar
Phone
Roofing
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 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
Phone# 'zt�>— Email
Type or Print Name 4! 110,
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE