HomeMy WebLinkAbout914 W LAKE ST - PERMITS - 10/27/1983City of �V6rt Collins BUILDIINGV INSPECTION'wD1 1Si:ION
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
Applicant complete this part of form only.
Press firmly using ball poin en.
Job Address " f
Name
Mail Address
O
Phone
Name
Address b
O
License No.
Phone
c
.Q
Lot
Block
Filing Number
y
Subdivision
0
PUD
J
DESCRIPTION OF WORK
fff � F
•f�
Stock Options
Plan No. Codes
Est. Total Cost
(including labor, material, profit)
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 construction.
f--
/f
signed ;j ! 1 err z date`-
- CLASS OF WORK -
New Alteration Addition Demolish Move
❑ ❑ ❑ ❑ ❑
Plbg. Mech. Elec. Struct. Fire Prot.
Occ. Gr.
Type Const.
Use Zone
Use of Building
Floor Area
Height
No. Stories
Lot Area
Frontage
Occ. load
Occ. Change from
Plat File No.
No. D.U.
Garage area
Fin. Bsmt. area
Type heat
No. Fireplaces or stoves
- RELEASES - Dates
Zoning
Engineering
Fire Department
Electric Department
Water & Sewer
Plan Review
Special Conditions:
Valuation FEES
Plan Check
Permit
Parkland
City Sales Tax
St. Oversizing
Water Plant Investment
Sewer Plant Investment
Storm Drainage
Electric Underground
Total Fees,
Off -Street Parking
(No.,Cars)
Interior Lot
❑
Corner Lot
❑
Reversed Corner Lot ❑
m
m
0
N
^^-2
N
M
rn
c
0
ti
Street
c
0
2
ZBA Case #
Date
BBA Case #
Date
Building Insp. Approval
by fi` date '
A)2
,Permit'No, _, �,t
Date
Distribution; Original -Applicant; Blue Office; -Canary - sales Tax; Pin6'-Applicant: Tag -Bldg. Insp.