HomeMy WebLinkAbout605 W Lake St - Applications/Change of Use - 05/04/2009BUILDING PERMITS & INSPECTIONS DIVISION
r P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760
www.fcgov.com/building
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER OC;? `5 APPLICATION DATE
Job Site Address LO S \1. l.Avr,
Unit #
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone
# 110 -,?aS-017 O
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Last Name (a1.,5T�n>Y► First Name 5
Middleo Rr T
Street Address 400 Ck>rfH G rA-q c_T City ForCoLL / na s
State�_Zip 0 0 5-.2.5
CONTRACTOR INFO: Company Name Contractor Phone #
Lic. Holder Name City of Fort Collins License #
Supervisor Cert #
Mailing Address City
State Zip
LEGAL INFO:
Subdivision/PUD ,-,�LI'iFiling #� Lot # 3
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Block # Lot Sq Ft ! 0SO SF
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage Sq Ft
Residential Sq Ft Comm'I Sq Ft # of Stories Bldg Height # Dwelling Units
15t Floor Sq Ft - 2nd Floor Sq Ft Unfinished Bsmt Sq Ft
Finished Bsmt Sq Ft
# of Bedrooms # of Full Baths �_ 9/4 Baths 'h Baths # of Fireplaces
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Air Conditioning: Yes No Energy info: (Circle appropriate choice) 1. ComCheck
2. ResCheck w/Air Sealing
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3. ResCheck w/Blower Door 4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing
6. Prescriptive w/Blower Door
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City of Fort Collins Stock Plan # List appropriate option #s
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UTILITIES INFO:
Water Tap Size Y-to 4'0 Sewer Tap Size rE�1t4•T"'t Metere :Yes No
Temp. Pedestal: Yes or
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only): ❑ 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $ — ®
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Description of Work: CLL0L m u rr T �t NC Lc �AYh L ✓ R O ehr-
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140 NpL) oNytcucT(oM
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical (af Mechanical ;Xi 16: Plumbing
Framer Roofing Concrete h1A Other
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Applicant: I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature Print Name��»,6s�, 'S uAMqTTan. Phone
Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE