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HomeMy WebLinkAbout3415 W Prospect Rd - Applications/Basement Finish - 03/08/2019/a) City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES 281 N. College Ave. •Fort Collins, CO 80524 •Phone: 970.416.2740 • www.fceov.com/building BUILDING PERMIT APPLICATION FOR OFFICE USE 4PPLICATION NUMBER: 19 f �� I APPLICATION DATE: Job Site Address 311/ r w, /Jrds/Ii4 ,eel • Unit# PROPERTY OWNER INFO: (All owner information is required — NOT optional) Last Name 9 r j w 1*7 First Name Middle Street Address 3 y15— A PJf P„steel— City State (/0 Zip Phone# 117o-2/5-2?:75 Email .IAVM Name of Business (COMMERCIAL USE ONLY) CONTRACTOR INFO: Company Name License Holder Name 0 whrd (,-. G. `oc LIC # CERT # LEGAL INFO: Subdivision/PUD %-•i 19o,iJli A) 4vrr/1r,.,k Filing # . Z Lot # 1 DW Block # Lot Sq Ft 0 t� / CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) Total Garage Sq. Ft. Residential Sq Ft .2Vo 9 Commercial Sq Ft # of Stories Z 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 '1 7 ° / # of Bedrooms a # of Full Baths I % Baths % Baths # Fireplaces ENERGY INFORMATION: (CHECK ONE) ComCheck ❑ UA (ResCheck) ❑ SPA (Simulated Performance ❑ prescriptive❑ Alternative) Air Conditioning? YES ❑x NO ❑ City of Fort Collins Approved Stock Plan # SPO List Option #s ERI(Energy Rating Index) ❑ UTILITIES INFO: Gas 0 Electric ❑ Electric Temp. Pedestal Yes ❑ No x❑ 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 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: Value of Construction (materials and labor): $ % -;ZD ,O a'` rF/ H irk. 4 ✓rw Description of Work: 9y iv d a scram Pn/ -A?✓irs/. , H c Z^dj n Ir r e- cs ✓ec, e)111L h,t Aa// 61A/✓d0-✓7. JOBSITE SUPERVISOR CONTACT INFO: Name i k h 13 SUBCONTRACTOR INFO: Electrical /-a.1-014m Sens F_ Ife-4br Phone '770 - Z/ 5 Z 7-7 s- Mechanical T/-_�,,//, rrs tii�{ins Rtel 0/. Plumbing �,v1� Pau S, .� S Framing Roofing Fireplace 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 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. 171Ou se- 6a , /f 2 00z 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 o VV Phone# ✓J7o—Z/5-- 27 :75-- Email 26row4 c5ti CJrivNa;/, tmt- THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE