HomeMy WebLinkAbout122 3rd St - Applications/Patio Cover or Sunshade - 06/14/2019City of
F6rt Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
FOR OFFICE USE
APPLICATION NUMBER: 4' I �T_)L41C (D APPLICATION DATE:
Job Site Address 64
PROPERTY OWNER INFO: (All owner I ormation is required — NOT optional)
Unit#
Last Name i 4R 2),=-- , At - first Name 19A�jA-\/nn,Q Middle
Street Address 122 3't� ✓YIY�P� City FOA-7- CaZzLL � State cO Zip q°
Phone # 3 03 64-/ 3S Email �2 d4hlb 6aJ-be'n_- (2. M P -
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name
License Holder Name
LEGAL INFO:
Subdivision/PUD
Filing # Lot #
LIC # CERT #
Block # Lot Sq Ft
CONSTRUCTION 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)
ComCheck ❑ UA (ResCheck) ❑
Air Conditioning?
# of Bedrooms
# Fireplaces
SPA(Simulated Performance ❑
Alternative)
YES ❑ NO ❑
City of Fort Collins Approved Stock Plan # SPO
# of Full Baths
Prescriptive❑ ERI(Energy Rating Index) ❑
List Option #s
UTILITIES INFO: Gas ❑ Electric ❑ Electric Temp. Pedestal
Electric Main Breaker Size (Residential Only): 150 amp or less ❑
ZONING INFO: (COMMERCIAL USE ONLY)
Yes ❑ No ❑
200 Amp ❑ Other ❑
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)
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): $ 9?w q • F0
Description of Work: f,2 U'&
Name
Phone
SUBCONTRACTOR INFO: Electrical Mechanical
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).
xI 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 Cityl of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature Qvu,MD tb e Type or Print Name )qlV-PIA I1V,O Ya4A&l -)41,4
Phone # 3 D 33 3 -- &�73s73 Email � 0�k?�J &d 1-��• C049
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE