HomeMy WebLinkAbout904 Elm St - Applications/Addition or Alteration - 01/16/2020FitCity of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
CoMns
281 N. College Ave. o Fort Collins, CO 80624 o Phone: 970.416.2740 o www.fu:ov.com/building
BUILDING PERIlAfTi,4PPf_ICATION
FOR OFFICE USE , ^ n
APPLICATION NUMBER: �J� APPLICATION DATE:
Dab Site Address , q
PROPERTY OWNER INFO: -(All owner information is required — NOT optional)
Last Name First Name . ,)R Middle
Street Address %S,4 40er f City
Phone #S%7-p Z/':� �� Email Mai
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name
License Holder Name %r�d a /,o c
Unit#
StateZo Zip 8S 2'�
LEGALINFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) Total Garage Sq. Ft. `:3 r
Residential Sq Ft /33�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 # 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[X
If for a new tenant, is this the first tenant to occupy this space?
Yes ❑ No X If not for the initial tenant for this unit, what was the previous use of this tenant space?
61'/ a � iZ C
Are there any exterior building changes (including mechanical) associated with the work? Yes No ❑
If yes, please describe: de {/Qm a -rrcyO w.41) i� �,q ,-- 14rg e r to f ^ do p j
112—
Value of Construction (materials and labor): $
Description of Work:
JOBSIYE SUPERVISOR CONTACT INFO: Name j /IGg VGJrjl Phone �'7-D qC)7 4
SUBCONTRACTOR INFO: Electrical %G Mechanical
PlumbingA-a[y&aC 71d,MbinC.0.,(`Vaming(�`jgra — /Jfel7-W Roofing
Fireplace —�^ 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 forAsbestos Containing Materials (A.Ws).
❑ 1 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 asbeitos-inspection has not been conducted on this property. • • • — — -
Applicant: 1 hereby acknowledge that I have read this application and state that the above information incorrect 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 (�/1,���5 Ale rT/,/
Phone # p 70 qO:2 l y9 -j Email C Ale 11 r✓/� / S- � ���Y � � Cn '"A
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE