HomeMy WebLinkAbout4900 SMALLWOOD CT - APPLICATIONS - 2/20/2020City of
/11'F6rt Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
Q FOR OFFICE USE
APPLICATION NUMBER: 57W 14 o� APPLICATION DATE: Z'Zo, W
Job Site Address
Unit#
PROPERTY OWNER INFO: (All owner information is required — NOT optional)
Last Name qo$ First Name l Middle
Street Address _LW
II�� SM6 (��— City _� j�S State ��Zip
Phone# e-tjU^ 2Zl— !' q9 —Email H L4,1r Z013 (o 6mPki. .eel _
Name of Business (COMMERCIAL USE ONLY) _
CONTRACTOR INFO: Company Name
License Holder Name M ,4:17— C
LEGAL INFO:
Subdivision/PUD fir. '�j� ti =Filing # Lot # Block # Lot Sq Ft
CONSTRUCTON 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 Lg6e % Pr
Finished Basement Sq Ft # of Bedrooms —# of Full Baths
Baths � % Baths # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ 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 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): $
�2 qq
JOBSITE SUPERVISOR CONTACT INFO: Name �n`` Phone
UBCONTRACTORINFO: Electrical I echanical 1;F rangy
umbingVA If Framing j I�-i�c1.1iC Roofing �-
Fireplace Solar J\ f% — Other n/%
ASBESTOS STATEMENT DI CLOSURE: 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: I hereby acknowledge that I have read thi application and state that the above information is correct and agree to
comply with all requirements contained herein and Ci of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature Type or Print Name W-±cf
Phone # 4 IrI% e7 _-7 —
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE