HomeMy WebLinkAbout622 W LAUREL ST - APPLICATIONS - 5/16/2019City of
FN` Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
M.
G PERMIT APPLICATION
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1FOR OFFICE❑SE
PPLICATION NUMBEkj JJ J n "yAPPLICATION DATE:
Job Site Address
PROPERTY OWNER INFO: (All owner information is requir�e/�d�— NOT optional)
Last Name � VL First Name � V I C7s'a
Street Address 9 (7(7 lni {I' o o y, f a i / tcity Fp C Ilan
Phone # O Email rliowSe Of r\ernni
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name I_11
License Holder Name \(r5 (k(A o, h10 C r-e2
LEGAL INFO:
Unit#
e�'
Middle DSO Y)
State CD Zip IM �
0
LIC # ICERT #
Subdivision/PUD I Z-Z — Qejlawin Filing# Lot# (Jr Block# y Lot Sq Ft
CONSTRUCTON INFO: Total Building Sq Ft (NOT includin basement) a Total Garage Sq. Ft. ()Q�
Residential Sq FtI 0�0 Commercial Sq Ft &&OW # of Storft, ; Bldg Ht # of Dwelling UnitsJ
1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft Unfinished Basement Sq Ft
Finished Basement Sq Ft io 3 D # of Bedrooms 7 # of Full Baths
Baths % Baths # Fireplaces
ENGERGY INFORMATION: (CHECK ONE)
(Simulated Performance
ComCheck ElUA (ResCheck) El SPA Alternative) PreSCrlptlVe❑ ERI(Energy Rating Index) El
Air Conditioning? YES NO I
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas ER Electric ® Electric Temp. Pedestal Yes ❑ No ❑
Electric Main Breaker Size (Residential Only): 150 amp or less N 200 Amp ❑ Other ❑
ZONING INFO: (COMMERCIAL USE ONLY)
Proposed Use: (i.e. medical, office, bank, retail, etc.)
For Commercial remodels and tenant finishes, please answer the following questions:
Is the remodel/tenant finishes for an existing or new tenant? (Please check one)
Existing Tenant❑ New Tenant❑
If for a new tenant, is this the first tenant to occupy this space?
Yes ❑ No ❑ If not for the initial tenant for this unit, what was the previous use of this tenant space?
Are there any exterior building changes (including mechanical) associated with the work? Yes ❑ No HI
If yes, please describe:
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1 gad(
remojzI G
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JOBSITE SUPERVISOR CONTACT INFO: Name Mol
SUBCONTRACTOR INFO: Electrical Premier 100
Plumbing JCT P Lamer Framing 5N�
Fireplace Solar
O/'I^E( Phone �- d-V 1200
T;c Mechanical NAfdi A!r
3V%+(jl, jCn Roofing
Other
ASBESTOS STATEMENT DISCLOSURE: In accordance with the State of Colorado Senate Bill 13-152, property owners, applying for a
remodel permit, shall indicate their awareness about their property having been inspected forAsbestos Containing Materials (RCM's).
I do not know if an asbestos inspection has been conducted on this property.
An asbestos inspection has been conducted on this property on or about (enter date) f:4 t zol
❑ An asbestos inspection has not been conducted on this property.
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.
i �—
Applicant Signature Type or Print Name A5Q5 qarr-ell—
Phone # V 0 ,- C)Y/-/ 20 O Email
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE