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CITY OF FORT COLLINS
P.O. Box 580 � Q (-
Fort Collins, CO 80522 NOTICE OF BUILDING PERMIT. APPLICATION 8 J
Building Address r
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PROPERTY
LEGAL
Subdivision or P U.D. FilingNo.
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Lot No. Block No.
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DESCRIPTION
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Lot Area, {
Corner Lot:
Yes
al Street Frontage (lineal feet)
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Name
F_-r�/��"
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Phone ���
CONTRACTOR
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Address Po City r M State Zip Code
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Name
Phho'nee
OWNER
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Address y, State Zip Code
Single Family Commercial El Number of Un1t'T0FZM 69.47
BUILDING
TOTL 69.47
_
Multi -Family ❑ Other: CHCX 69.47
Ai23192 1!J10, Yi
TYPE OF
IV. e" `o
Ga Electric ❑ Heat Pump ❑ Baseboard ❑ Radiant ❑ Other:
HEAT
WATER AND
Water Tap Size:
�
❑ Flat
SEWER
Sewer Tap Size:
Metered Rat
(
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Drainage Basin
tMtC t (k5� t (24IL4
Gross Area
' v I
iSTORMWATER
g se Rate
Runoff Coefficient
Detention Reduction Factor
Floodpl
UTILITY$
77
A
Yes No
i fro be
Utility Fund Number
Storm Drainage Basin Fee
completed
by others)
+ ,n, / ( (� (3
�7 w ' 'G Yl� G+. i -
„ -7
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Stormwater Utility Signature
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NOTE:
I understand that the Storm Drainage Basin Fee must be paid prior to the issuance of a Car-,
tificate of Occupancy. I further understand that if drainage improvements are required for
this site, two (2) copies of a drainage report and a drainage plan, signed and stamped by a
APPLICANT
Colorado -registered Professional Engineer, ust be submitted to the Stormwater Utility for
approval before a ificate of Occupa cy III be issued.
Signature of p is
Date:
DISTRIBUTION 1 1. Original: Applicant — 2. White: Building Inspection — 3. Gold: Stormwater Utility — 4. Blue: Transportation Utility -
- 5. Pink: Light & Power — 6. Yellow: Water & Sewer
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