HomeMy WebLinkAbout1817 Longworth Rd - Applications/Addition or Alteration - 07/06/2020City of
F, rt 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:�'�TZ�� APPLICATION DATE: '1, l . Zo
Job Site Address Unit#
PROPERTY OWNER INFO: (All owner inforrnAtion is required — NOT optional)
Last Name Ytc,�—yt,r Firs Name I e Middle
Street Address City— A State _Zip gor-,
Phone # Email JaS _ t L1U . e blr�al C A INN
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name
License Holder Name �cJl ��,� LIC #
LEGAL INFO:
Subdivision/PUD
CERT #
Filing # Lot # Block # Lot Sq Ft
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) 1 15,g 5 Total Garage Sq. Ft. �0 O
Residential Sq Ft Commercial Sq Ft # of Stories Bldg Ht # of Dwelling Units
1st Floor Sq Ft ) 54g 5 2nd Floor Sq Ft 3rd Floor Sq Ft
Finished Basement Sq Ft 0 # of Bedrooms Z .
Baths % Baths i # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
Unfinished Basement Sq Ft
# of Full Baths
COmCheck ❑ UA (ResCheck) ❑ SPA(Simulated Performance ❑ prescriptive❑ ERI(Energy Rating Index) ❑
Alternative)
Air Conditioning? YES ')g NO ❑
City of Fort Collins Approved Stock Plan # SPO
List Option #s
UTILITIES INFO: Gas Electric-�'C Electric Temp. Pedestal
Electric Main Breaker Size (Residential Only): 1SO amp or less -8
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 TenantLnl 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:
41F
$ -K 606
Description of Work:
JOBSITE SUPERVISOR CONTACT INFO: Name Phone C1�()A a L zq)y
SUBCONTRACTOR INFO: Electrical .Li e, km) c- Mechanical
Plumbing FramingRoofing
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 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 requirements contained herein and City of Fort Collins ordinances and state laws regulating building construction.
ApplicantS(iggnnature TypeorrPrintName
Phone # Email C�'o } �,� if it C
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE