HomeMy WebLinkAbout2426 Marshfield Ln - Applications/Addition or Alteration - 04/01/2019� t of
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
(, � FOR OFFICE USE
APPLICATION NUMBER: r ` IL�. APPLICATION DATE: 4 /-
Job Site Address 2YZ& /G4SIU1C)
PROPERTY OWNER INFO: (All owner information is required — NOT optional)
Last Name &EI t C4C1 First Name
Street Address _7 g26 Mi( (sk-A, / City
Phone # `3 ( D —763(.--.5 Email A
Name of Business (COMMERCIAL USE ONLY)
Unit#
Middle
State _Zip
CONTRACTOR INFO: Company Name 19f In\ S\.e, ",Q_Ac License Holder Name LIC # CERT #
LEGAL INFO:
Subdivision/PUD 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 T Unfinished Basement Sq Ft_
Finished Basement Sq Ft
# of Bedrooms
# of Full Baths
Baths % Baths # Fireplaces
ENGERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑ SPA (Simulated Performance ❑ prescriptive❑
Alternative)
Air Conditioning? YES ❑ NO ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas ❑ Electric ❑ Electric Temp. Pedestal
Electric Main Breaker Size (Residential Only): 150 amp or less ❑
ERI(Energy Rating Index) ❑
Yes ❑ No ❑
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:
Description of Work:
JOBSITE SUPERVISOR CONTACT INFO: Name
SUBCONTRACTOR INFO: Electrical
Plumbing Framing
Fireplace Solar
Phone
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).
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 (j'l{�-� Type or Print Name 1AA I IL'R a te-ht ei
Phone # Email
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE