HomeMy WebLinkAbout425 W MULBERRY ST - APPLICATIONS - 11/19/2010BUILDING PERMITS & INSPECTIONS DIVISION
P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 1,5a
www.fcgov.com/building
City of Fort Collins BUILDING PERMIT APPLICATION
APPLICATION NUMBER ! APPLICATION DATE / /y / q' 10
Job Site Address
W .
(All owner information is required - it is not optional)
Last Name Y \ w \�t1S�.Jt�..I �X'_51 First Name
Street Ad
Phone #
Unit #
Middle
�-7 - State(-t zip 005�Z5�
CONTRACTOR INFO: Company Name i�}) Contractor Phone
IN
Lic. Holder Name of Fort Collins License # Supervisor Cert #
Mailing Address ��, City V--TZ--- State CO zip
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (not including basement)
Residential Sq Ft Comml Sq Ft # of Stories
Total Garage Sq Ft
Bldg Height # Dwelling Units
15S Floor Sq Ft 2nd Floor Sq Ft Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft
# of Bedrooms # of Full Baths 1/4 Baths '/2 Baths # of Fireplaces
Air Conditioning: Ye No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing
3. ResCheck w/Blower Door 4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing 6. Prescriptive w/Blower Door
City of Fort Collins Stock Plan # List appropriate option #s
UTILITIES INFO:
Water Tap Size Sewer Tap Size Metered: �Yesr No Temp. Pedestal: Yes o No
Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only):
0 150 Amp or Less ❑ 200 Amp ❑ Other
Value of Construction (including labor, material & profit) $
Description of
Contact Name & Phone # of JOBSITE SUPERVISOR:
Subcontractor Info: N
Electricals Mechanical Plumbing
Framer Roofing Concrete Other
Applicant: I hereby ackno ledge that I h ve read this ap ication and state that the above information is correct and agree to comply with all requirements
contained herein and City of Fort Co ins o ' an nd to laws regulating building construction.
Applicant Signature Print Name — Phone
Distribution: White - Office Yellow - Applicant Pink - WWW/Stormwater
THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE
City Of Planning, Development and Transportation
F69 t Collins PO Box 580
281 N College 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:
Addition
Remodel/ F
<' 'Z\'ZZ
Building owner address: L=7
Building owner phone #:��
Name of Business:
Proposed Use: (i.e. medical, ofDficebank, retail, etc)
Project square footage:
For commercial remodels Er tenant finishes, please answer the following questions:
➢ Is the rem det enan ishes for an (please circle answer)
xisting tenan or new tenant?
r
➢ If for a new tenant, is this the first tenant to occupy this space? Yes r =No
➢ If not the initial tenan&-t'
is unit, what was the previous use of this tenant
Space? O c �1
➢ Are there any exterior building changes associated with the work? Yes rrNo
If yes, please describe:
Signature oT appTtcant
Name (please p t)
W o
Date
- 'zk-z-a-r
Local daytime phone #