HomeMy WebLinkAbout429 E Magnolia St - Applications/Addition or Alteration - 04/08/2019FlirtCity of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Collins 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcoov.com/building
BUILDING PERMIT APPLICATION
FOR OFFICE USE
APPLICATION NUMBER: rz)I q aa I-1 I APPLICATION DATE:
Job Site Address
PROPERTY OWNER INFO: (All owner information is required — NOT optional)
Unit#
Last Name 'ram ��,� 3a n First Name 'Te .rr ss Middle
Street Address 9 a o ✓I n� i c� City Jr „r a ((,„ S State _Zip
Phone # 393 -? Email eccs� OIC ke44rnr.- thper , s _ P®M
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name A P 6encj-e,- ( CCA-.MC-V,,4 )
License Holder Name A ,^ h P L h p2 LIC # CERT #
LEGALINFO:
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
Finished Basement Sq Ft
Baths
2nd Floor Sq Ft 3rd Floor Sq Ft
Baths
ENERGY INFORMATION: (CHECK ONE)
# of Bedrooms
# Fireplaces
Block # Lot Sq Ft
Total Garage Sq. Ft.
Bldg Ht # of Dwelling Units
Unfinished Basement Sq Ft 76 '5-
# of Full Baths
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 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, please answer the following; questions:
Is the remodel/tenant finishes for an existing or new tenant? (Please check one)
ERI(Energy Rating Index) ❑
❑ 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 ❑
If yes, please describe:
Value of Construction (materials and labor):
$ Fzoo
Description of Work:
JOBSITE SUPERVISOR CONTACT INFO: Name
SUBCONTRACTOR INFO: Electrical
Plumbing oc�lnp PI(Aw��r�h 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 rein and City of Fort Collins ordinances and state laws regulating building construction. H�
Applicant Signature Gam" Type or Print Name Z D %✓��
Phone # 92!0 30e- 3 3 $D Email
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE