HomeMy WebLinkAbout1100 Cobblestone Ct - Applications/Addition or Alteration - 05/24/2019v
City of
Fort Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
2r FOR OFFICE USE
4PPLICATION NUMBER:.�h6,7J101 APPLICATION DATE: .IQ q )�
Job Site Address Unit#
PROPERTY OWNER INFO: (All owner information is required - NOT optional)
Last Name Srz- 'rf, First Name SCo'T Middle ADO nrA,CA-
Street Address (� 6City �'o(� Co[ [ ii1 O State Co zip G'alzT
Phone # 770 0 /7 26 0 2 Email �Sc.hr►,; (o./m
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name 5e
License Holder Name LIC # CERT #
LEGAL INFO:
Subdivision/PUD Filing # Lot #
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) _
Residential Sq Ft1,6 ommercial Sq Ft # of Stories_
1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft
Finished Basement Sq Ft
% Baths % Baths _
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑
# of Bedrooms
# Fireplaces
Block # Lot Sq Ft
Total Garage Sq. Ft.
Bldg Ht # of Dwelling Units
Unfinished Basement Sq Ft
# of Full Baths
SPA(Simulated Performance ❑ Prescriptive[]ERI(Energy Rating Index) El
Alternative)
Air Conditioning? YES f1i NO [I
City of Fort Collins Approved Stock Plan # SPO
List Option #s
UTILITIES INFO: Gas 0" Electric ;]'Electric Temp. Pedestal Yes ❑
Electric Main Breaker Size (Residential Only): 150 amp or less ❑ 200 Amp
ZONING INFO: (COMMERCIAL USE ONLY)
Proposed Use: (i.e. medical, office, bank, retail, etc.)
For Commercial remodels and tenant finishes. alease answer the following questions:
Is the remodel/tenant finishes for an existing or new tenant? (Please check one)
No ❑
Other ❑
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 I<
If yes, please describe:
- --
Value of Construction (materials and labor): $ 4&igu 2,ODD
Description of Work: AA—k Lz ek rpt^�— -4 Cou�A-e-( -\ oP
k---)ATemed—
JOBSITESUPERVISOR CONTACT INFO: Name 40- Phone q'-40 a)7-Q«p�...
SUBCONTRACTOR INFO: Electrical
Plumbing Framing
Fireplace Solar
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 for Asbestos 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 co amed herein and Ci of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature s .4 Type or Print Name S'�-(trb- Sc,1 \ �k.-
Phone# �'j70 a" ZGOZ Email S'SC-hnMg 1(29M Ca\AN
U
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE