HomeMy WebLinkAbout3336 Green Lake Dr - Applications/Single Family New - 02/07/2019 (2)FoCityofCOMMUNITY DEVELOPMENT'& NEIGHBORHOOD SERVICES
rt ®1 6 Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fceov.com/building
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BUILDINGPERMIT APPLICATION
(� G FOR OFFICE USE
PPLICATION NUMBER: l� 1 16USH a APPLICATION DATE: --2- -]
Job Site Address 3336 � �_N {44 8P, Unit# Z C(mds J
PROPERTY OWNER INFO: (All owner information is required - NOT optional) ✓
Last Name 50114+i13 First Name cezi Middle
Street Address 3�O{q KtNGtr-ISHEje CTCity •WINWk State (12 Zip acs-iO
Phone # C[jo � :jr- q-'I- Email 424 ( / aU `LQ Mgd C'0 '-
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name TZ}I(.Iimo f(,bm&,.5
License Holder Name G Z3-0 .5 LIC # C2 ^n/(I CERT #
LEGAL INFO: d
Subdivision/PUD Filing# 1- Lot# Block# LotSgFt 310 1
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) Total Garage Sq. Ft. 118q
i
Residential Sq Ft J, S43 Commercial Sq Ft _# ofStories Bldg Ht_3:7 # of Dwelling Units
1st Floor Sq Ft' ORS 2nd Floor Sq Ft 5SO 3rd Floor Sq Ft 'Unfinished Basement Sq Ft
Finished Basement Sq Ft / # of Bedrooms 3 # of Full Baths Z
% Baths Y2 Baths # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑ SPA (Simulated Performance p ❑ gY g Prescri tive ERI(Ener Rating Index) ❑
Alternative)
Air Conditioning? YES - .I!j. NO ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s - / ,
UTILITIES INFO: Gas X 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 j ZA '�
Description of Work: 4MJ Q s��r� 1 Y%�' UP1-Ti'—
R pF A 2 ON c-T -} r10M C L! N 9 i=_✓�
JOBSITE SUPERVISOR CONTACT INFO: /Name Phone
SUBCONTRACTOR INFO: Electrical KIJ�,\Gnl�/�% Mechanical �•�- �• 1 1 , *'J .
Plumbing . �' S ' Framing AWTLQ-k C011c• Roofing &tm etoF1A16I
Fireplace Solar Other
ASBESTOS STATEMENT DISCLOSURE: in accordance with the State of Colorado Senate Bill 13-1SZ property owners, applying for a
remodel permit, sholl 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.
Applicant: I hereby acknow ge that I ave read this application and state that the above information is correct and agree to
comply with all requireme t c Ine erein and City of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature `�g�r��t Nam ��'QI
Phone 4 okTv Email WA l{� ''��p-`w �YllLb
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE