HomeMy WebLinkAbout642 Smith St - Applications/Garage - 05/21/2019l
City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
�F,.�ort Collins
281 N. College Ave. •Fort Collins, CO 80524 •Phone: 970.416.2740 • www.fceov.com/buildine
BUILDING PERMIT APPLICATION
PPLICATION NUMBER: 3�{3S
FOR OFFICE USE APPLICATION DATE: S l�jj �I q Q
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Job Site Address k 2 C164 �`l Unit#
PROPERTY OWNER INFO: (All owner information is required — NOT optional)
Last Name ��C(,�e� First NameMiddle
Street Address qd, 6�j�/ `j 61 City �1 /��� State azip �Q<j`Fl
Phone #- WC- 3ra -15�� Email C`�iPa(-( �O�0 G/IYL�A/�
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name l [uP��-
License Holder Name j�!(f�� LIC # CERT #
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) Total Garage Sq. Ft. 3 � q ()o
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 # of Full Baths
% Baths Yz Baths # Fireplaces
ENGERGY INFORMATION: (CHECK ONE)
(Simulated Performance
ComCheck ElUA (ResCheck) El SPA Alternative) [IPrescriptive❑ ERI(Energy Rating Index) ❑
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.)
For Commercial remodels and tenant finishes. please answer the followine 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:
JOBSITE SUPERVISOR CONTACT INFO: Name Phone
SUBCONTRACTOR INFO: Electrical {� �q O� (� Mechanical
Plumbing Framing A tZ &dd-r Roofing
Fireplace Solar TCJe-J Other
ASBESTOS STATEMENT DISCLOSURE: in accordance with the State of Colorado Senate Bill 13-152, property owners, applying for a
remodel p it, 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 requirement contained f5ecei nd City of Fort Collins ordinances and state laws regulating` building construction.
Applicant Signature \ Type or Print Name 6-11 r (�m�
Phone# '7�Q-6'02=_ Email
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE