HomeMy WebLinkAbout1668 Shenandoah Cir - Applications/Basement Finish - 06/21/2019City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F,`rt Collins
281 N. College Ave. •Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fceov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER:
FOR OFFICE USE iT
I' l � � ��a �L7 APPLICATION DATE:
Job Site Address 1 6 6 g s��� A ti D LC. �. co(j s, Co 0<'0S-z5Unit#.
PROPERTY OWNER INFO: (All owner information is required — NOT optional)
Last Name i C.,Dx First Name T R+C__ Middle /V
Street Address R,,ja. GLpca Gx 6r, City r cf C-0 f cyi S State UD Zip g0 S Z S
Phone #_ Q7D--21,Lf--7QD3 Email
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name
License Holder Name LIC # CERT #
LEGAL INFO:
13NK3
Subdivision/PUD Go (ca,, lueuAo-_j s Filing # •,.,•3 Lot # Z ,3 Block # 7 Lot Sq Ft 7 7 6 1?
CONSTRUCTION INFO: Total Building Sq Ft (NOT including basement) 2 2. q3 Total Garage Sq. Ft. % g tl
Residential Sq Ft z 2 q 3 Commercial Sq Ft -- # of Stories 2 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 �;gg # of Bedrooms' Ll # of Full Baths
Baths I Y2 Baths # Fireplaces (
ENERGY INFORMATION: (CHECK ONE)
(Simulated Performance
ComCheck [IUA (ResCheck) ElSPA Alternative) ❑ Prescriptive❑ ERI(Energy Rating Index) ❑
Air Conditioning? YES J9 NO ❑
City of Fort Collins Approved Stock Plan # SPO
List Option #s
UTILITIES INFO: Gas 0 Electric ❑ Electric Temp. Pedestal Yes ❑ No ❑
Electric Main Breaker Size (Residential Only): 150 amp or less W 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 fallowing 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:
Value of Construction (materials and labor): $ 6r (�QQ 15
Description of Work:..:r�ii�s(1 lnasemevjf r- retoarc;�, t�v-Ls/ ih.sfu.L( LoAr-o6wm
CV/toilet. S�ower2 X� wa1U r 0 cLcD1 fin. G�(alr�enr O(/1C
1Ur q f- r aw"sec ron.y, <-v, c(or, p k- 1,4 Leo-va c4tn`5CLe
JOBSITE SUPERVISOR CONTACT INFO: Name Phone
SUBCONTRACTOR INFO: Electrical Mechanical
Plumbing 4AUCL A C(?,\ -Ptu- , Framing Roofing
Fireplace Se"' �� Solar 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) M c,V 2(-949'-7
❑ 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' I afe Al ..1�� - C 1, p
Phone # q 70 . -Lt q - 7 Email fa-�t!�,r i, trL S � �D �vv�c� l • c� +v� "
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THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE