HomeMy WebLinkAbout615 S LOOMIS AVE - APPLICATIONS - 9/23/2019�t of
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
/A FOR OFFICE USE
APPLICATION NUMBER: / (L� APPLICATION DATE:
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Job Site Address 6/-S j EZD ? l
PROPERTY OWNER INFO: (All owner information is
Last Name First Name
Street Address 6/5 57 �,� —Z!&✓ City
Phone #7Z2) WO-9'6r-&Email
Name of Business (COMMERCIAL USE ONLY) /
CONTRACTOR INFO: CompanyName �v
License Holder Name //j/�+�j?/ �//�%�gXGt/lij/I LIC # CERT #
G
— NOT optional)
Unit#
LEGALINFO:
Subdivision/PUD
Middle
�7' �r06�j7P State C.p
Zip 4@L2
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Filing # Lot # Block # Lot Sq Ft
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement)
Residential Sq Ft Commercial Sq Ft # of Stories
1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft
Finished Basement Sq Ft
# of Bedrooms
% Baths % Baths # Fireplaces
ENERGY INFORMATION. (CHECK ONE)
Total Garage Sq. Ft.
Bldg Ht # of Dwelling Units
Unfinished Basement Sq Ft
# of Full Baths
ComCheck ❑ UA (ResCheck) ❑ SPA (Simulated Performance ❑ Prescriptivez ERI(Energy Rating Index) ❑
Alternative)
Air Conditioning? YES gr NO ❑
City of Fort Collins Approved Stock Plan # SPO
List Option #s
UTILITIES INFO: Gas 011", Electric Electric Temp. Pedestal
Electric Main Breaker Size (Residential Only): 150 amp or less ❑
ZONING INFO: (COMMERCIAL USE ONLY)
Yes ❑ No ❑
200 Amp Other ❑
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 in. u ing mechanical) a oci teal ` Ith.p work? Yes IZ No Eles If 0!'t S�j>ailP��i /ur� � A
yes, Please describe: u/%ir��. GlJYI ��lou % yYJ0�7/ c%Gi i1,4
I Name
Mechanical
�l�1! Framing �i�y�tl�avH�.�• Roc
Fireplace y// Solar A?,/ 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 (ACM's).
❑ 1 do not know if an asbestos inspection has been conducted on this property.
i� An asbestos inspection has been conducted on this property on or about (enter date)
❑ 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 lawsregulatingbuilding construction.
Applicant Signature��/ Type or Print Name `% elmy
Phone # .�Ly Email
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE