HomeMy WebLinkAbout4700 Lady Moon Dr - Applications/Tenant Finish - 12/17/2019F6City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
rt Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
j� FOR OFFICE USE
APPLICATION NUMBER: rMl 1![ APPLICATION DATE: 11'•17.1'
Job site Address 4700 Lady Moon Drive, Fort Collins, CO
)ROPERTY OWNER INFO : (All owner information is required — NOT optional)
Last Name First Name Middle
Street Address City G7rte- State Zip 8 631
Phone # �+o 430 /q / 3 Email
Name of Business (COMMERCIAL USE ONLY) Banner Health
CONTRACTOR INFO: Company Name Swinerton Builders
License Holder Name Kerry Swain LIC # B_367 CERT #
LEGAL INFO:
Subdivision/PUD Banner Health medical Campus Filing # Lot # _Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (NOT including basement) Total Garage Sq. Ft.
Residential Sq Ft Commercial Sq Ft 520 # of Stories 1 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) [I SPA Alternative) (Simulated Performance ❑ Prescriptive❑ ERI(Energy Rating Index) ❑
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.) Staying as Medical
For Commercial remodels and tenant finishes, please answer the Commercial remodels and tenant finishes, please answer the following
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): $ 430,135
Description of Work:
Interior remodel of the Compounding pharmacy space to ring to current needs and adjacent space as requires
IOBSITE SUPERVISOR CONTACT INFO: Name Randy Sullivan Phone 970-430-1413
SUBCONTRACTOR INFO: Electrical
Encore Electric
Plumbing US Engineering Framing
Fireplace
Solar
Mechanical US Engineering
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 for Asbestos Containing Materials (ACM's).
I
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 Type or Print Name Matthew Curtis
Phone # 720-951-0387 Email matthew.curtis(a)swinerton.com
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE