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City 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
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Mail Address-
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Phone
Name
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Address'
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License No. ';
Phone
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Lot
-
Block
Filing Number
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Subdivision
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PUD
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DESCRIPTION OF WORK
0
Clio 0497
Stock Options
Plan No. Codes
Est. Total Cost
lincluding 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- ---
Dlstrlbuban Original - AppLcanL Blu - Sice, angry - Sales T Fi - pp6cant: Tag _Idg. Insp.
— CLASS OF WORK —
New Alteration Addition Demolish Move
❑ ❑ ❑ ❑ ❑
Plbg. Mech. Elec. Struct. Fire Prot.
❑ ❑ ❑ ❑ ❑
Occ. Gr.
Type Const.
Use Zone
Use of Building
FloorArea
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
... t"
Parkland
City Sales Tax
St. Oversizing
Water Plant Investment
Sewer Plant Investment
-
Storm Drainage
Electric Underground
yty
Off -Street Parking
(No. Cars)
Interior Lot
❑
Corner Lot
❑
Reversed Corner Lot
❑
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d
_IV
( 1
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0
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Street
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.:7
ZBA Case #
Date
BEA Case it
Date
Building Insp. Approval
by date
Permit No.
ate