HomeMy WebLinkAbout615 W LAKE ST - PERMITS - 4/2/2009City of Neighborhood & Building Services
`r 281 N. College Ave. Fort Collins, CO 80522-o58o
F6rt Collins Phone: 970-221-676o Fax: 970-224-6134
1�1�1``►.� BUILDING PERMIT #: B0901387
Issued Full: 04/02/2009
Permit Type: Change Of Use
Site Address: 615 W LAKE ST
Job Valuation: $1.00 Category: Rooming/Boarding House
Owner: KELLY, JEANNETTE M
2125 CALLE TE COLOTE
SANTA FE, NM 87505. Phone: 505-603-0547
Zoning: Front setback: Rear setback: Right setback: Left setback:
Zoning district: HMN Plat File #: 1600-26 ZBA Case #: Minor Amend #:
Legal: Subdivision/PUD: Filing #: Lot #:
Code: Res sq ft: 0 Com sq ft: Ind sq ft: Basement sq ft:
# of stories: Occ Group: Const Type:
Stock plan #: Stock plan options:
Contractor: License #: Supervisor cert #:
Phone:
Subcontractor(s) Phone License Number
J/
Block #:
Work Description: CHANGE OF USE FROM A SINGLE FAMILY TO A 5-person EXTRA OCCUPANCY RENTAL
HOUSE (AKA BOARDING HOUSE)
** SCHEDULE INSPECTIONS *** By Phone: 221-6769 *** By Web: http://aaweb.fcgov.com/CitizenAccess**
Inspections: FNB
TOTAL FEES PAID AS OF 04/02/09 $100.00 Payment method: Check 1574
"* Fee Detail Displayed on Next Page
As a condition for the issuance of a permit, I hereby declare that I am the owner or owners agent, authorized to perform the proposed work on the property described herein.
I agree to comply with all the requirements contained herein, and City ordinances, and State laws associated with such work. I understand that such pen -nit may be
revoked in the event that issuance was based on incorrect information. This permit shall become null and void if the work authorized by such permit is not commenced,
suspended, abandoned or not inspected within 180 days from the date of such permit.
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Signatur4WZ:C
Print Name%Date:Form Revis
Neighborhood & Building Services
281 N. College Ave. Fort Collins, CO 80522-o58o
Phone:970-221-676o Fax:970-224-6134
BUILDING PERMIT #: B0901387
Issued Full: 04/02/2009
Permit Type: Change Of Use
Site Address:
615 W LAKE ST
Job Valuation:
$1.00 Category: Rooming/Boarding
House
Transactions
Method
Check Number Date Paid
Amount Paid
Comments
Check
CK# 1574 03/13/2009
$100.00
PAID BY HANDY RANDY RANDY PASQUINELLI CK
#1574
Receipt issued:
04/02/2009 Total Paid to Date:
$100.00
Fee Description Account Code
Fee Amount
Amount Paid Date Paid Amount Due
Permit Flat Fee - $100
1000.422010
$100.00
$100.00 03/13/2009 $0.00
TOTAL FEES: $100.00 $100.00 $0.00
TOTAL BALANCE DUE AS OF 04102/2009: $0.00
Fee Amounts are valid for date of this document only. Fees subject to change without notice.