HomeMy WebLinkAbout6303 Treestead Rd - Applications/Basement Finish - 01/10/2020City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
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281 N. College Ave. o Fort Collins, CO 80524 o phone: 970.416.2740 o www.fceay.com/building
BUILDING PERMIT APPLICATION
rr� FOR OFFICE USE
APPLICATION NUMBER (� I APPLICATION DATE:
Job Site Address 6 3 03 1 f-,ec 5 fur - %Z j\- Lo Unit#
PROPERTY OWNER INFO: (AIL owner information is required — NOT optional)
Last Name 5p y-, (,o uo-L First Name �>Qw L
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Middle
Street Address :3 1`6'�P.P S Co 1k%b State L5L5���
Phone# 3c3 ?6V 7g43 Email
Name of Business (COMMERCIAL. USE ONLY)
CONTRACTOR INFO: Company Name IZ�0
License Holder Name b — 5 L)(y IJ LIC # b— 51(C) CERT #
LEGALINFO:
Subdivision/PUD (A)•e5T C_�\Ws8 , Filing # Lot # 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_
Finished Basement Sq Ft ) 'b 6 0 # of Bedrooms I # of Full Baths
Baths % Baths # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheI:6 ❑ SPA (Simulated Performance ❑ prescriptive❑
Alternative)
Air Conditioning? YES ❑ NO Q'
City of Fort Collins Approved Stock Plan # SPO
List Option #s
UTILITIES INFO: Gas 33 Electric K�r-ElectricTemp. Pedestal
Electric Main Breaker Size (Residential Only): 150 an1D or less ❑
ERI(Energy Rating Index) ❑
Yes ❑ No ❑
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
If yes, please describe:
Value of Construction (materials and labor): $ 5 Z . p 3
Description of Work: 15 r-ctiwa CN--K F I \\3 %S V\
JOBSITE SUPERVISOR CONTACT INFO: Name Phone 9-?Q 56-7
SUBCONTRACTOR INFO: Electrical' Mechanical$
Plumbing Roofing
Fireplaces Solar 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 for Asbestos Containing Materials (ACM'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)
❑ An asbestos inspection has not been conducted on this property.
Applicant: 1 hereby acknowledge that 1 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 Type or Print Name �z te�"X G�C"ti
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Phone T10 (�� dC�b3 mail �..c )Pitt ci G� Pa%tc�e rL
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE