HomeMy WebLinkAbout1420 Banyan Dr - Applications/Addition or Alteration - 05/09/2019City of
�F6rt Collins
TION NUMBER:
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. "• Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION DATE: "l'Vlw
Job Site Address �a, (- a Unit#
PROPERTY OWNER INFO: (All owner inforrakion is required — NOT optional)
Last Name r�� �n/� First Name /(��JAe/ Middle
Street Address 4,V, A) City � ����Je�_l�_State � Zip
Phone # �-9L� yl Email?�
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name
License Holder Name 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.
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
Baths
Baths
ENERGY INFORMATION: (CHECK ONE)
# of Bedrooms
# Fireplaces
# of Full Baths
ComCheck ❑ UA (ResCheck) ❑ SPA(Simulated Performance ❑ Prescriptive❑
Alternative)
Air Conditioning? YES ❑ NO Vf
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas ❑ Electric E/ Electric Temp. Peeddesta
Electric Main Breaker Size (Residential Only): 150 amp or less E
ZONING INFO: (COMMERCIAL USE ONLY)
ERI(Energy Rating Index) ❑
I Yes ❑ No ❑
200 Amp ❑ Other ❑
Proposed Use: (i.e. medical, office, bank, retail, etc.)
For Commercial remodels and tenant finishes, please answer the following auestions:
Is the remodel/tenant finishes for an existing or new tenant? (Please check one)
Existing Tenantl..f� 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 2
If yes, please describe:
Value of Construction (materials and labor):
Description of Work: ��>�
$V3, eV
JOBSITE SUPERVISOR CONTACT INFO: Na Phone v,�—kg2y,Z S\5
SUBCONTRACTOR INFO: Electrical M chanical
Plumbing Framing Roofing
Fireplace 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 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 1 have read this application and state that the above information is correct and agree to
comply with all requirements contained herein and City of Collins ordinances and state laws regulating building construction.
Type or Print Name
i
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE