HomeMy WebLinkAbout6836 TIMPAS DR - APPLICATIONS - 1/31/2020of
F City
Collins COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
FOR OFFICE USE
APPLICATION NUMBER: APPLICATION DATE: i 3�
Job Site Address (D "6_b (9 T ; YK Dr. For' co
PROPERTY OWNER INFO: (All owner information is required —
optional)
Unit#
Last Name /Vf sor First Name P-46 ck Middle TseRk
Street Address CocdaCn -ri!' n s 17(• City ror+ L''on;.,q State Go Zip $pga
Phone # � 70 (oqs ��pc( Email prel on )y ® a MoLi 1. COM
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name
License Holder Name
LEGAL INFO:
Subdivision/PUD
Filing # Lot #
LIC # CERT #
Block # Lot Sq Ft
CONSTRUCTION INFO: Total Building Sq Ft (NOT including basement) Total Garage Sq. Ft.
Residential Sq Ft Commercial Sq Ft # of Stories Bldg Ht # of Dwelling Units
1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft ",,Unfinished Basement Sq Ft QaD
Finished Basement Sq Ft 4/0 of Bedrooms ( x# of Full Baths
�/o Baths D �—;� Baths D �# Fireplaces O
ENERGY INFORMATION: (CHECK ONE)
ComCheck El UA (ResCheck) ❑ SPA(Simulated Performance ❑ prescriptive❑ ERI(Energy Rating Index) ❑
Alternative)
Air Conditioning? YES ❑ NO ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas ❑ Electric ❑ Electric Temp. Pedestal Yes ❑ No ❑
Electric Main Breaker Size (Residential Only): 150 amp or less ❑ 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 followine auestions:
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 ❑
If yes, please describe:
Value of Construction (materials and labor): $
%Description of Work- Z wd( be nt
r
JOBSITE SUPERVISOR CONTACT INFO: Name
SUBCONTRACTOR INFO: Electrical
Plumbing
Fireplace
Framing
Solar
Phone
Mechanical
Roofing
Other
A
-I-
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).
a
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)
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.
Applicant Signature �j ,� Q , 71-etg,7✓1 Type or Print Name P�+6A 7- /VdSovi
x Phone # C(%Q- (pig— Email P6 eI 601,1 14f
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE