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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 L'�0;
;fi. � . Name �=wf w� :.�+-� L�;� ���•t',r�. ..
r
Mail Address;x f a Jy
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P b��i e...Fi}i, tY t6v.K':•ti....[./ ^y^,^,+J1ia
Phone
0
Nameli! . t+
Address
O
License No i°�''
Phone^.
Lot
Block
Filing Number
N
Subdivisions&:
76
PUD
Parcel #
DESCRIPTION OF WORK
�/
'-/� 3o iviarV
Stock Options
Plan No. dd Codes
Est. Total Costf' '" t
(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.
R
signed
— CLASS OF WORK —
New Alteration Addition Demolish Move
❑ ❑ 0�f_ ❑ ❑
Plbg. Mech. Elec. Struct. Fire Prot.
❑ ❑ [it, ❑ ❑
Occ. Gr. f„?"
Type Const. /
Use Zone
Use of Building -ems
Floor Area 20
Height
No. Stories
Lot Area
Frontage
Occ. load
Occ. Change from
Plat File No.
No. D.U.
Garage area
Fin. Bsmt. area
Type heat �� r,:'�
No. Fireplaces or stoves
— RELEASES — Dates,
Zoning I& f ��
Engineering
Fire Department �� Sn
r f
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation f ]�"� FEES
� `
Plan Check'-�
Permit
Parkland
City Sales Tax
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
[T,ota41,Fe'es_-
w �. 6 Wiz. r �. � i .' , �
Distribution: Original - Applicant; Blue.-� OfLce "Canary -Sales Tax; Pink -^Applicant; Tag -Bldg. Insp.
f�i
Off -Street Parking AjfT$
(No. Cars)
Interior Lot ❑
Corner Lot O+`.
tiReversed
Corner Lot ❑
pk
1
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cC
1�
4'S t ��
0
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1 1 cn
c �
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Street
IN al E'. is 4.119 -e 1. .. 4'17,
Ct•�_ S � � � it•
P�AliMTS 132u9't7
T?'1XPM 171.87
tOTL 304.8
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CHCit 39.1
N285 i 1 212., 29 A
ZBA Case # Date
BBA
Case # Date
Building ln`sp: Approval
,I/
by ,
r' Y date
o
Permit No.i -W
r� yq ,Date r •i =
-34