HomeMy WebLinkAbout4430 Vista Dr - Applications/Basement Finish - 05/16/2019}
City of
Fort Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 8OS24 • Phone: 970.426.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
(APPLICATION NUMBER: f 1JIL? 3?j(p,9, APPLICATION DATE:
Job Site Address
Unit#
PROPERTY OWNER INFO: (All owner information is required — NOT optional)
Last Name First First Name l Middle
Street Address City State & Zip D
Phone # Email � c _�� a in cIQA/&Fn "-'/,� 1A 1 I ClipName of Business (COMMERCIAL USE ONLY) �
CONTRACTOR INFO:
License Holder Name
LEGAL INFO: I V / 3 —
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) 7, (QL) 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 I # of Full Baths ^"rj'V`l'
Baths % Baths # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
COmCheck ❑ UA (ResCheck) ,y❑1�
Air Conditioning? YES tj
(Simulated Performance
SPA Alternative) ❑ PresCrlptive❑ ERI(Energy Rating Index) El
NO ❑ C04a:k 406M+Ar H-Sb39
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas ❑ Electric $ Electric Temp. Pedestal Yes ❑ No ❑ c
Electric Main Breaker Size (Residential Only): 150 amp or less ❑ 200 Amp 9 Other ❑ —
ZONING INFO: (COMMERCIAL USE ONLY)
Proposed Use: (i.e. medical, office, bank, retail, etc.) N j19
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 Tenanto New Tenant❑
If for a new tenant, is this the first tenant to occupy this space?
Yes 2[ No ❑ If not for the initial tenant for this unit, what was the previous use of this tenant space?
Are there any exterior bui ing changes (including mechanical) associated with the work? Yes Af No f
If yes, please describe: PMfj d EYNfi Y1A Allt
Name 11/J%- )l V'IBl YVII1 Phone
SUBCONTRACTOR INFO: Electrical 11" C0IMechanic/a)lc
Plumbing f Framing �Y �i(1RF� ing
Fireplace NDD DS7 Solar Other
ASBESTOS STATEMENT DISCLOSURE: 5Ycordance 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 (RCM's).
Ef 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 asbestos inspection has not been conducted on this property.
Applicant: I hereby acknowledge that I
comply with all requirements contained
Applicant Signature
% Phone # 70
have read this application and state that the above information is correct and agree to
herein and City of Fort Collins ordinances and state laws regulating building construction.. ""
Type or Print Name j e %' Sk,
Email
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE