HomeMy WebLinkAbout1005 Driftwood Dr - Applications/Addition or Alteration - 09/13/2019City of
F6rt 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
4PPLICATION NUMBER: V\14II� APPLICATION DATE:
Job Site Address It90 S � 2�7. 0242e Unit#
PROPERTY OWNER INFO: (All owner information is required — NOT optional)
Last Name ` � T �i//i/!�%f�l First Name kL 24'7Z' f Li Middle
Street Address OyS 4y X-rwya-/ City `j State CZ Zip
Phone # �j ���s�� Email
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name
License Holder Name %/�l/f/YJ/�j �/,�%s�i}u/��� LIC # CERT #
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) Total Garage Sq. Ft.
Residential Sq FtS_Commercial Sq Ft # of Stories 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 Y2 Baths # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ElUA (ResCheck) ElSpA Simulated Performance ❑ prescriptive❑ ERI(Energy Rating Index) ❑
Alternative)
Air Conditioning? YES ❑ NO ❑
City of Fort Collins Approved Stock Plan # SPO / List Option #s
UTILITIES INFO: Gas IJ Electri/ ❑ Electric Temp. Pedestal Yes f_��No El
Electric Main Breaker Size (Residential Only): 150 amp or less El200 Amp IJ 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:
X'
iA
Value of Construction (materials and labor):
JOBSITE SUPERVISOR CONTACT INFO: Name J%dgx Phone
SUBCONTRACTOR INFO: Electrical �CIP((pI-tou���L/Il�j,f _Mechanical
Plumbing ��,yTytl� ) lb' raming Roofing
Fireplace Solar Other
ASBESTOS STATEMENT DISCLOSURE: /n accor once ith the State of Colorado Senate Bill 13-152, property owners, applying for a
rernodel-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: 1 hereby acknowledge that I have read this applicationand state that the above information is correct and agree to
comply with all requirementscont fined herein City of FortCollins ordinances and state laws regulating building construction.
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Applicant Signature Type or Print Name,
Phone # 3-es �/ LJ5 0 Email h)(x-e) req/�jD, Tf�(Aiyi�,. G2 rh—,
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE