HomeMy WebLinkAbout6038 Fall Harvest Way - Applications/Basement Finish - 07/15/2020' City 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: 3�Z-dUAPPLICATION DATE: I)YI
Job Site Address bom, mt,twwirunty Unit#
PROPERTY OWNER INFO: (All owner information is required - NOT optional)
Last Name indl?s 1� First Name F72- I (, Middle
Street Address cvulff'5 State _()Zip D5 Z81
Phone #!�J-+p Email to yy)ct rt� 2l hrr> mc�( �r►�
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name /VA`j-/I/C DEXIG,A) /3vtlU{J r LLL
License Holder Name �1(�:aZO ML,SD7J LIC # �q'/ CERT #
LEGAL INFO:
Subdivision/PUD Filing # Lot #
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement)
Residential Sq Ft Commercial Sq Ft # of Stories
1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft
Finished Basement Sq Ft / p # of Bedrooms
% Baths % Baths # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑
Air Conditioning? YES ❑
SPA(Simulated Performance ❑
Alternative)
NO ❑
City of Fort Collins Approved Stock Plan # SPO
Block # Lot Sq Ft
Total Garage Sq. Ft.
Bldg Ht # of Dwelling Units
_Unfinished Basement Sq Ft 10D
# of Full Baths I
Prescriptive❑ ERI(Energy Rating Index) ❑
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 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): $ G
JOBSITE SUPERVISOR CONTACT INFO: Name s IlfirnJ l„ J/ Phone
SUBCONTRACTOR INFO: Electrical ga1g9j !1) Mechanical
Plumbing �'� (,�(�,n(r Framing
Fireplace
Solar
A[ft"il lie- Roofing
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).
❑ 1 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 herein and City of Fort Collins ordinances and state laws regulating building construction.
Applicant Signatur „ (�, Type or Print Name Lyl LS Or/
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE