HomeMy WebLinkAbout424 PINE ST - APPLICATIONS - 8/15/2011City
}of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rt Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-2211-6766
w*W.fcgov.com/bulhflng
BUILDING PERMIT APPLICATION
APPLICATION NUMBER , . _-�j.� APPLICATION DATE- - - ✓
Job Site AddressN_�� , �� f` �0�3-y_ Unit #.
PROPERTY_.OWNER INFO: (All owner information is required -'it is not optional) Phone #! `f 70
Last name _ _ILAw Cr . First Name. A"ev C- i
- .. � - - ---Middle -
I - -
Street Address/ �Al Ef ((�� City fG RT CG / A� s State �O Zip�-
- - -
CONTRACTOR INFO: Company Name W N1 N Kr-IA-N--) f'bN57lkt--CrA*tontractorflhohe # 4170.2 i 7-%'qSq
Lic Holder Name ���i g /e I /V Wl*l ^J City of Fort Collins License # _ __ __ __ _ Supervisor Cert
Mailing Address ?;-Q� ZE X D CityFG R I—AW-7ih.S State. - (0__ __ zip _ 0
LEGAL INFO:
Subdivision/PUD _ _ .. Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement) Total Garage. Sq Ft
Residential Sq Ft __ _ _ _ _ Comm'l Sq Ft # of Stories Bldg Height # Dwelling Units
11, Floor Sq Ft 211' Floor Sq Ft
3rd Floor Sq Ft -__ _ Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft _ _. _ # of Bedrooms # of Full Baths % Baths _ _ _ '/2 Baths # of Fireplaces
Air Conditionings. Yes No Energy info:( Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. Simulated Performance Alternative S. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan # List appropriate option #s i
UTILITIES INFO:
Water Tap Size Sewer Tap Size - _ Metered: Yes or No Temp. Pedestal Yes or No
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)
Descripbo i,of
Contact'Name, & Phone # of JOBSITE SUPERVISOR: t5Nkr'j b oN
70-5f
Electrical _l�t_Q L~GrG n_ Y Mechanical H14YIU LF S Plumbing ty wG� �s
Framer i�i3�S�i!. jgE E K Roofing ��_ Concrete ��� Fireplace
Other _. ___ _ _ Other
Other
Applicant I hereby acknowledge that I ha read this pplication and state that the above information is correct and agree to comply with all requirements
contained herein and City of Ilins roan and to laws regulating building construction.
Applicant Signature __ Print Name n'0&G , C- /� ANOZ hone
Distribution: White_Office Yellow —Applicant Pink —WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE
C of
c F
Planning, Development and Transportation collins ryt PO Box 580
281 N College Ave
Ft 911Cdllins c 0805.24
04913 970-221-6760 phone .970-224-6134 fax
Commercial Construction Application Information
P.
Revised 01/1012009
Application Number:
Job Site Address: Lk2fAVE C,- #100 FL
New Building Addition Remodel/TF
Building owner; 0�_n 1<
Building owner address.- XA P I t-4 F_
Building owner ;phone #.-.
Name of Business:
Proposed Use: (i.e. rnedical, office, bank, retail, etc) Y I A- \`
Project.square footage: ----------
For commercial remodels & tenant finishes, please answer the following questions:
> Is the rem ooebTe—n—ahLfLnishes for an (please circle answer)
("ng tensW or new tenant?
> If for a new tenant; Is this the first tenant to occupy this space? Yes or No
> If not the. initial tenant for this uniti, what Was the previous use of this tenant
Space?
> Are there any exterior building changes associated with the work.? Yet c(_
If' yes, please describe:
applicant
Nameprint)
Date
70 - 75,(y_
Local daytime phone #