HomeMy WebLinkAbout120 W Stuart St - Applications/Addition or Alteration - 03/15/2019City of
Flirt Collins
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
NPPLICATION NUMBER: APPLICATION DATE:
Job Site Address /010 yj S'('Gcr'+'i 5; . -Xco , Co 90d;tts Unit# 14
PROPERTY OWNER INFO: (All owner information is required — NOT optional)
Last Name NOP k5- First Name JA171 Middle C
Street Address /2.760 Aw eoun4cy Slug City 4&sli \ State 1-k Zip
Phone # -7 3.2— jboD Email dbe'f 50 ( 494r"16�a►Y
Name of Business (COMMERCIAL USE ONLY) 5y10,ell QiigC� S rG_j{4 �eh IG��C�?5
CONTRACTOR INFO: Company Name �>'�� ¢o i li $lti eo,tSiYucfjty'1
License Holder Name C1\4e) Pr; C sf LIC #
LEGAL INFO:
Subdivision/PUD
Filing # Lot #
CONSTRUCTION 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 _
ENGERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑
# Fireplaces
CERT #
Block # Lot Sq Ft
Total Garage Sq. Ft.
Bldg Ht # of Dwelling Units
Unfinished Basement Sq Ft
# of Full Baths
W7 3T'
SPA(Simulated Performance ❑ prescriptive❑ ERI(Energy Rating Index) ❑
Alternative)
Air Conditioning? YES ❑ NO ❑
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.) %�(,r.Ad
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 the work?
Yes
No ❑
with
If yes, please describe: /tJc7 f0 %l�iT� �6 /�G./Kiin�' �06 �keP�
arc
C'li<ev�rer,
Value of Construction (materials and labor): $ Iq 14 ;oo
Description of Work: -FQrn 11.1 $'prices ikj-) G. /lfiSev( A'Aa- endore,-�
a fie nee.
191
JOBSITE SUPERVISOR CONTACT INFO: Name Cl� %�i^tG'Jf- Phone q%p - 3VJ - 3C30c�
SUBCONTRACTOR INFO: Electrical Mechanical At
Plumbing Framing
Fireplace Solar
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 contained herein and City of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature Type or Print Name TL,4� 0(-., 1
Phone# %(va -Y5o -FYoq Email-51,a4.� 10 SPaek-Qcu9oc��-AL
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE