HomeMy WebLinkAbout3615 Big Dipper Dr - Applications/Basement Finish - 01/13/2020F, City of
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
0 + 7
FOR OFFICE USE
NPPLICATION NUMBER: O� 0OO 6 U q APPLICATION DATE: I I3 � aoac�
Job Site Address
PROPERTY OWNER INFO: (All
is required — NOT optional)
Last Name Aver First Name
ke_j�CG 0.
Middle
Unit#
Street Address 14 (,< 13, a ICI A!% ]Or. City ror j —State-ico Zip
Phone # 97.- 213- D010 Email rkycr y_tl:D p c dsc oo19, 12 f9
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name r'an,v i-�O,nar,-LLC.
License Holder Name G�;)I;a.., 4rur.cI; LIC#L��CERT# C�
LEGAL INFO:
Subdivision/PUD J,tMIDU) l2ronk Filing# Lot# 1Block# Lot SgFt
CONSTRUCTION INFO: Total Building Sq Ft (NOT including basement)
Residential Sq Ft Commercial Sq Ft # of Stories
1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft _
Finished Basement Sq Ft 15-b # of Bedrooms I
Y4 Baths — % Baths — # Fireplaces —
ENERGY INFORMATION: (CHECK ONE)
Total Garage Sq. Ft.
Bldg Ht # of Dwelling Units
Unfinished Basement Sq Ft
# of Full Baths
ComCheCk ElUA (ResCheck) El SPA (Simulated Performance ❑ Prescriptive❑ ERI(Energy Rating Index) El
Air Conditioning? YES ❑ NO ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas ❑ Electric ❑ Electric Temp. Pedestal
Electric Main Breaker Size (Residential Only): 150 amp or less El
ZONING INFO: (COMMERCIAL USE ONLY)
Yes ❑ No ❑
200 Amp ❑ Other ❑
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 I
If yes, please describe:
Value of Construction (materials and taboo : $ 0. 0a I $ O 0 O O
Description of Work: ame-,ne-. " Ao inriiudt Re-dloo,., L41 QAt ioo,+-),
(dJs,4- RA r,
JOBSITE SUPERVISOR CONTACT INFO: Name %3; )1 F u,t's L,- Phone j7 p -s 9 y— k 7 93
SUBCONTRACTOR INFO: Electrical C O„d,lG-f /T(I Mechanical L6 c l� i
Plumbing,nCo l ora.(o
r �Jrn%,n
Fireplace
Framing
Solar
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).
ES 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 a d City of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature ' - � Type or Print Name LIJi) �i.�... E. 6vnc�; Jj-
Phone# quo8'793 Email �fg„.,erv%p Ou-f/ook COW,
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE