HomeMy WebLinkAbout6321 Fossil Creek Cir - Applications/Basement Finish - 07/03/2019City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Flirt Collins
281 N. College Ave. •Fort Collins, CO 80524 •Phone: 970.416.2740 • www.fceov.com/buildins
BUILDING PERMIT APPLICATION
FOR OFFICE USE o�✓
4PPLICATION NUMBER: � � � 4lc�0 APPLICATION DATE:
Job Site Address 6 �? / J.5-5 / Cy-eej CI r. r of �!�'1 � , CD 76S� Unit#
PROPERTY OWNER INFO: (All owner information is required —'NOT optional)—t—
Last Name 0 I & Yi rl or— First Name Er i VL Middle Ta me-9
Street Address 63AI F6SS'I ) l.►mk W-City 9 CD(I lyls State _Zip BDS�g'
Phone #q7_0-Email e_oCoV\nor`,9ps�SG�Dd�Se r5rcf
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name e ocyh er
,
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 /,2()
Finished Basement Sq Ft g 5-6# of Bedrooms # of Full Baths
% Baths Y2 Baths # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑ 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.)
For Commercial remodels and tenant finishes. please answer the followine auestions:
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): $ l(p QQQ . ®b 2�,
Description of Work: f/ hef �Pe n� /a Cpq°P , In
3' 1AII-- j r�
✓Y!G) /;I _ I-erm Wl W/,c � /.JP� bar—. �Y1 ea-I-'nn u (( A'A
JOBSITE SUPERVISOR CONTACT INFO: NameCy/n 660V7/�r-CA0MeAjjy)eC)Phone 770 -211g4- &_716
SUBCONTRACTOR INFO: Electrical kQ rMechanical /Lana
Plumbin Framin 1 V��
g XS Mvl n g II t M oofing n
Fireplace /)ka Solar /i ZA 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 E7rl vi Cohn B r
Phone # 976 6 Email & CO n n or- Co R! O 5C OD I 5, D Y-0
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE