HomeMy WebLinkAbout1601 S College Ave - Applications/Electrical - 03/22/2019City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
�F�ort Collins
281 N. College Ave. Fort Collins, CO 80524 Phone: 970.416.2740 www.fceov.com/buildin¢
BUILDING PERMIT APPLICATION
FOR OFFICE USE
APPLICATION NUMBER: APPLICATION DATE:
Job Site Address C� 11'e 5 e- AC1C-51r-
PROPERTY OWNER INFO: (All owner information is required - NOT optional)
Unit#
Last Name L:)Cbr CEr'C_l�rsC CO First Name Middle
Street Address P(' �jp�( qC%s City L,jS . State
Phone # 'j%O - `ISye- ��S Email
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name
License Holder Name Al be`1 CAA-116...l LIC #
LEGAL INFO:
Subdivision/PUD
L'16 Zip 2�
�3 CERT #
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) Total Garage Sq. Ft.
Residential Sq Ft 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 % Baths # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑ SPA(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 ❑ 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.)
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:
Description of Work: J< e l211AC -e—
JOBSITE SUPERVISOR CONTACT INFO: Name
SUBCONTRACTOR INFO: Electrical r lad
Plumbing Framing
Fireplace Solar
O
ov
4,jeZ Phone S 3-_ -a979
C_ Mechanical
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).
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)
❑ An asbesto's 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 require ` ' ntained erein and City of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature Type/or Print Name/ /Co r_/
Phone# _36_3 722- Email d'd
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE