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Clty 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 CID q ;A
Namer . f.o • U,: ,
Mail Address.
i ,
[1
03
a•M5, 60
Phone} r
Name
Address !
kf
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0jr
License No. }., Phone
a
Lot
Block t, c,, '" �
Filing Number
N
Subdivision
PUD
m
Parcel # (y` 7- -y 0-
DESCRIPTION OF WORK
Stock Options
Plan No. Codes
Est. Total Cost•
(including 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.
date
5lc (
— CLASS OF WORK —
New Alteration Add' ' n Demolish Move
❑ ❑ ❑ ❑
PI❑g. . Me h Ele Struc . Fire❑Prot.
Occ. Gr. Const.
Use Zone
Use of Building
/
FloorArea Heig! ;
No. Stories
t
Lot a �' �drnta
Occ. loa5,o
O c. ge from
Plat Fil
t,iy
No. D.U.
Garage area
Fin. Bsmt. area
Type heat
No. Fireplaces or stoves
— RELEASES — Dates
5
Zoning a { W, ,
Engineering
Fire Department
Electric Department
Water & Sewer y e
Plan Review ( Z
Special Conditions:
./�� ���^s G='r'"'°'""". f � Cam" t.✓' 1
Valuation _ Cry FEES
Plan Check
Permit f,
Parkland
City Sales Tax
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
jT_tal Fees,; k�,
._
Distribution: Original - Applicant; Blue - Office; Canary -=a 11 Tax;jPink - Applicant Tag-- Bldg. Insp. - � %,) ~ — ~'
Off -Street Parking
(No. Cars)
Interior Lot
❑
Corner Lot
❑
Reversed Corner Lot
❑
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a
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Street
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C
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ZBA Case #
Date
BBA Case #
Date
Building Insp. ( Approval
by
date
Pe'rmi �V0.
Late
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