HomeMy WebLinkAbout221 MATHEWS ST - PERMITS - 10/19/1983City of Fort Collins
BUILDING INSPECTION DIVISION
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only.
Press firmly using ball point pen.
Job Address ')a
Name . V _
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Address I r
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Phone
Name�,�.
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Address r
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License No.
Phone
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Lot
Block
Filing Number
Subdivision
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DESCRIPTION OF WORK
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Stock Options
Plan No. Codes
Est. Total Cost
tincluding labor, material, profit)
I hereby acknowledge that I have read this application and
state that the above is correct and agree to comply with all city
ordinances and state laws regulating building construction.
r _
- ----signed
— CLASS OF WORK —
New Alter ion Addition Demolish
❑ ❑ ❑
Move
❑
Plbg. Me Elec. Struct.
❑ ❑ ❑ ❑
Fire Prot.
❑
Occ. Gr.
Type Const
Use Zone
Use of Building
Floor Area
Height
No. Stories
Lot Area
Frontage
Occ. load
Occ. Change from
Plat File No.
No. D.U.
Garage area
Fin. Bsmt. area
Type heat
No. Fireplaces or stoves
— RELEASES —
Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation FEES
Plan Check
Permit
Parkland
City Sales Tax
St. Oversizing
_
_
Water Plant Investment
Sewer Plant Investment
Storm Drainage
_
Electric Underground
`Total Fees
Off -Street Parking
(No. Cars)
Interior Lot
❑
Corner Lot
❑
Reversed Corner Lot ❑
0
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( 1
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Street
0
D
ZBA Case #
Date
B BA Case N
Date
Building
Insp. Approval
by
date
�0&'�)'
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Permit No.
I Safe
Distribution: Original - Applicant: BlueJoffice; Canary - Sales Tax: Pink - Applicant; Tag - Bldg. Insp.
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