HomeMy WebLinkAbout917 E Prospect Rd - Applications/Addition or Alteration - 11/18/2019City of
F`rt Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
CATION NUMBER: C71ql qu&
Job Site Address °, tic 1 �0 S �� (�L� �� k ' 3
PROPERTY OWNER INFO: (All owner information is required O,\T
Last Name f ' 1 '�' 61 &- - First Name --1-0V)
Street Address 6) li V , kp 5 City T-0&�"
Phone # r-)Z)r) f %(O�0 Email Sb,C.-e,-
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name
License Holder Name
LEGAL INFO:
Subdivision/PUD Filing # Lot #
CONSTRUCTON 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 # of Bedrooms
Baths % Baths # Fireplaces _
ENERGY INFORMATION: (CHECK ONE)
APPLICATION DATE: Ili
optional) A
1`
Unit#
�jW—/�?A�-mv ps l!
Middle
1
State zip �0 �15
it
LIC # CERT #
Block # Lot Sq Ft
Total Garage Sq. Ft.
Bldg Ht # of Dwelling Units
Unfinished Basement Sq Ft
# of Full Baths
ComCheck ❑ UA (ResCheck) ❑ SPA(Simulated Performance ❑ Prescriptive❑
Alternative)
Air Conditioning? YES ❑ NO ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s
ERI(Energy Rating Index) ❑
UTILITIES INFO: Gas Electric Z 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 following auestions:
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:
Value of Construction (materials and labor):
03 : m
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4K a.-,
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JOBSITE SUPERVISOR CONTACT INFO: Name --6 0 5�P Lb N "CA F-r--
SUBCONTRACTOR INFO: Electrical K—I NN rz:r I L �,— � (2( Viechanical
Plumbing TNT--r PWNL?)I
Fireplace
Phone �Q; -no -;�6o
Framing Roofing
Solar 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 for Asbestos Containing Materials (RCM's).
❑ 1 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) N\" 1 ` 0
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 requiremer;s i,ontained herein and City of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature VW V Type or Pri t Name
Phone # �jp�j �� '�ot7 l Emai�� '� e- i yr C.�,
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE