HomeMy WebLinkAbout1217 Columbine Ct - Applications/Addition or Alteration - 04/24/2019City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
�F`or_t Collins
281 N. College Ave. •Fort Collins, CO 50524 •Phone: 970.416.2740 • www.fceov.com/building
BUILDING PERMIT APPLICATION
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PPLICATION NUMBER: n I Cj APPLICATION DATE:
Job Site Address j Z k -i- C d 1. Vim � 10 r-- CT, Unit#
PROPERTY OWNER INFO: (All owner information is required -NOT optional)
Last Name W 1 S H I M 4A First Name M A4 C
Street Address
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Phone # J k CA L t q Email p/l Jk(2- N 1 S Kc A4 U It -
Name of Business (COMMERCIAL USE ONLY)
Middle T-
State (0 Zip � Zr
G-M A-( L . 644
CONTRACTOR INFO: Company Name
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(IV O VE MI I S
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License Holder Name S 12 k J� N
S 7-C-7-P
KC-N 5 0/V
LIC # g
19 CERT #
AVU1111111►1193
Subdivision/PUD Filing # Lot #
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement)
Residential Sq Ft Commercial Sq Ft # of Stories
1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft
Finished Basement Sq Ft
# of Bedrooms
% Baths Y2 Baths # Fireplaces
ENGERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑ SPA (Simulated Performance ❑
Alternative)
Air Conditioning? YES ❑ NO ❑
Block # Lot Sq Ft
Total Garage Sq. Ft.
Bldg Ht ', # of Dwelling Units
Unfinished Basement Sq Ft
# of Full Baths
Prescriptive❑ ERI(Energy Rating Index) ❑
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 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:
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Value of Construction (materials and labod. $ t
Description of Work: j pS T`RL L- D (-4-) \.( X ly1r f AJO CVO% D' r Q0 `I ) �S
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JOBSITE SUPERVISOR CONTACT INFO: Name
SUBCONTRACTOR INFO: Electrical
Plumbing
Fireplace
Framing
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 1� —Type or Print Name �ln�ip /1 �' M
Phone# 'f1� '� "1 ���}( 0 Email M-:UISMtA4 !(L-
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE