HomeMy WebLinkAbout4149 SUMTER SQ - PERMITS - 1/22/1986City 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
Name
iJ. gip,
5
c
Mail Address
3
O
Phone
`o
Name
Address
C
License No. Phone
°
Lot
Block
Filing Number
y
m
Subdivision
PUD
m
�
J
w
DESCRIPTION OF WORK
Stock Options
Plan No..—_ - -. Codes
Est. Total Cost _
tmclud'mg 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.
signed date
— CLASS OF WORK
New Alteration Addition Demolish Move
Q ❑ ❑ ❑ ❑
Plbg. Mech. Elec. Struct. Fire Prot.
® 4_ Q r ❑
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 "
s &Qa
Type heat
No. Fireplaces or uoves
— RELEASES = Dates
Zoning 5
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions: ti
Valuation <.,� `' / - ---.- FEES
Plan Check �"
r
S `
Permit
s
Parkland
City Sales Tax
- �£_ ✓ �-
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
Total Fees
"
,. }
! -
Dutnhu.. n O rrsl A I,r�nt. of v Ofhlr , r�hary - Snles lax Pink - Apoheant Teg - Bltla. Inso.
Off -Street Parking
(No. Cars)
Interior Lot
p
Corner Lot
❑
Reversed Corner Lot
❑
1 }
a�
cc
( I
( l
S
D �
U)
m n
c
0
ri
Street
c
0
9
ZBA Case #
Date
BRA Case #
Date
Building
Insp. Approval
byy
date
J)
Permit No.
Date