HomeMy WebLinkAbout416 JEFFERSON ST - APPLICATIONS - 10/27/2010City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
F6rt Collins 281 N. College Ave. • Fort Collins, CO 80522-0580 • Phone: 970-221-6760
www.fcgov.com/building
BUILDING PERMIT APPLICATION
APPLICATION NUMBER �_\, APPLICATION DATE ����%/�O
Job Site Address N Unit # -#4
PROPERTY OWNER INFO: (All owner information is required - it is not optional) Phone #
Last name 1 J -Zt.�L f w'Wc��D M e S First Name Middle p�,�
Street Address /� _ �^ 10 �% r.61k C� City J w �'' State6!9 / Zip
CONTRACTOR INFO: Company Name v Contractor Phone # q `fib
Lic Holder Name "� Q - City of Fort Collins License # G" �- 2 Supervisor Cert #
Mailing Address ` (D:x City r`' ����✓ State 00 ZipZ-
LEGAL INFO:
Subdivision/PUD
CONSTRUCTION INFO: Total Building Sq Ft (not including
Residential Sq Ft Comm] Sq Ft
15' Floor Sq Ft
2nd Floor Sq Ft
Filing # Lot # Block # Lot Sq Ft
Total Garage Sq Ft
# of Stories Bldg Height # Dwelling Units
3'd Floor Sq Ft
Unfiished Bsmt Sq Ft
Finished Bsmt Sq Ft # of Bedrooms # of Full Baths % Baths '/z Baths # of Fireplaces
Air Conditioning: Yes No Energy info: ( Circle appropriate choice ) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. Simulated Performance Alternative 5. Prescriptive w/Air Sealing 6. Prescriptive w/ Blower Door
City of Fort Collins Stock Plan #
UTILITIES INFO:
List appropriate option #s
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) $ �� �Od `� v
Description of Work: m�-�„`D ( vt�'+j �' U L
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info:
Electrical
Framer
Roofing
Mechanical
Concrete
/z�' V-\
Plumbing
Fireplace
Solar Other Other Other
Applicant: I hereby acknowl/F/
ve read this a lication and state that the above information is correct and(gree to comply with all requirements
contained herein and City of __a es d tate laws regulating building�Itruc, tion,
Applicant Signature Print Name J6-� Phone !��-5 67-v77�
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE
City of Planning, Development and Transportation
Fort Collins PO Box 580
281 N Cotlege Ave
Ft Collins, CO 80524
970-221-6760 phone 970-224-6134fax
Commercial Construction Application Information
Revised 03/30/2009
Application Number:
Job Site Address:
New Building
Building owner:
Building owner address:
Building owner phone #:
✓A-vno—
Name of Business:
Addition
17D-,V 72- E '-f
Proposed Use: (i.e. medical, office, bank, retail, etc)
Project square footage:
Remodel/TF W
For commercial remodels Ft tenant finishes, please answer the following questions:
➢ Is the remodel/tenant finishes for an (please circle answer)
existing tenant or new tenant?
➢ If for a new tenant, is this the first tenant to occupy this space? Yes or C�—O)
➢ If not the initial tenant for this unit, what was the previous use of this tenant
Space?
➢ Are there any exterior building changes associated ith the work? /,'Y&4 or No
If yes, please describer
Y)c4'
Signature of applicant
L /-454 a, g, . J
Name (please print)
Date
576' 567-0-)29
Local daytime phone #
EM l _.�
, MEA ,