HomeMy WebLinkAbout3324 Green Lake Dr - Applications/Single Family New - 02/07/2019 (3)Job Site Address 2,q CjeL7-r /j
PROPERTY OWNER INFO: (All owner information is required - NOT optional)
City Collins,
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcpov.com/building
BUILDING PERMIT APPLICATION
FOR OFFICE USE.
APPLICATION NUMBER: '[S1 j6D8j I APPLICATION DATE: oPM1
Unit# jg�oNl( -r4
Last Name Sa rJ laz.5' First Name G-15-0 Middle
Street Address N14L(ASLI'i'FIL 9 City 4%Al0L0.I<-_ State (W Zip
Phone # 9� fjb q�'�T Email 49,v epp,
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name T 4kl( ev' t' rifil(-.'s
License Holder Name oNi927's LIC # 4�. � ,CERT #
LEGAL INFO:
Subdivision/PUD Tal}11Jj1 Filing# _Lot# ___Block# _ Lot SgFt 3.31b.
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) Total Garage Sq. Ft. - B-tt--
Residential Sq Ft 11543 Commercial Sq Ft / # of Stories Bldg Ht -3# of Dwelling Units /
1st Floor Sq Ft Aka 2nd Floor Sq Ft SO 3rd Floor Sq Ft / Unfinished Basement Sq Ft
Finished Basement Sq Ft # of Bedrooms S # of Full Baths 2
Y4 Baths % Baths _ # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
(Simulated Performance
ComCheck ❑ UA (ResCheck) ❑ SPA Alternative) fZ,Prescriptive❑ ERI(Energy Rating Index) ❑
Air Conditioning? YES NO ❑
City of Fort Collins Approved Stock Plan # SPo cZPL6/(__List Option #s l
01
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 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): $ (9z i 2)
Description of Work: NJP_; ] IpGN 1I/-rIL uN r_S(ZAJJTr-M q=,E /dt ,`i
jl}2T p� A 2 N H 4-► A . CA✓4JY\6N
10BSITE SUPERVISOR CONTACT INFO: Name 4az 3'D Mtas Phone q 0 �;i 7 Q
SUBCONTRACTOR INFO: Electrical 091c®1J Mechanical E— G • �A A
Plumbing Sna • �WA1 , SO(, . Framing AM', t-Guk_ CZtA&q : Roofing P-,, V M 0&0004
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 bee
Applicant: I hereby
comply with all regi
Applicant Signature
Phone# -1_1
ucted on this property.
this application andstate that the above information is correct and agree to
City of Fort Collins ordinances and state laws regulating building construction.
Type or Print Name G�;i�)
Email (A,l� yl� Y�')4�, cz-P3- I
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE