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City Of FOY't 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 )
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Name
Mail Address f'
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Phone
Name
Address
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License No._-, ' r+
Phone
c
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a
Lot
Block
Filing Number
N
Subdivision
0
PUD
Parcel #
DESCRIPTION OF WORK
Stock Options
Plan No. Codes
Est. Total Cost 4
(including labor, material, profit)
0
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
/cyo(nnstr[}u�/c'tion.
1 ( I
signed &., '(_dbte t
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— CLASS,,EOF WORK —
New Alteration Addition Demolish Move
❑ 'O ❑ ❑ ❑
Plbg. Mech. Elec. Struct. Fire Prot.
❑ ❑ ❑ ❑ ❑
Occ. Gr.
Type Const.
Use�Zone
Use of Building
Floor Area e Height
V -- " .~
No. Stories/k`
Lot Area•
Frontage
Occ. load: .,
d /
i0'ce: Change from ) 4n
�.
Plat File No. ��•,N`ol
D.U.
Garage area r
Firi. Bsmt. area
Type heat
No. Fireplaces or stoves
— RELEASES — Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Spec ial,Con'ditions:
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Valuation "^y r , `_"_""" FEES
Plan Check
Permit`l
,v
[G,y
Parkland
i
City Sales Tax
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
Total
—_:
Distribution: Original -Applicant; Blue - Office; Canary -Sales Tax; Pink -Applicant; Tag - Bldg.lnsp
Off -Street Parking
(No.
Cars)
Interior Lot
❑
Corner Lot
❑
Reversed Corner Lot
❑
a
m
m
a,
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'7
Street
71 _
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ZBA Case #
Date
BBA Case #
Date
Building Inspr }`s Approval
by date
i'
-<�- --Permit No.
1
Date