HomeMy WebLinkAbout831 FOXTAIL ST - APPLICATIONS - 3/18/2019City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collins
281 N. College Ave. •Fort Collins, CO 80524 •Phone: 970.416.2740 • www.fcaov.com/buildine
BUILDING PERMIT APPLICATION
FOR OFFICE USE ��',,
APPLICATION NUMBER: 1 O 1�1 Q APPLICATION DATE: J1- `�- 11J
Job Site Address / �o j �A��/hS g6Sa Unit#
PROPERTY OWNER INFO: (All owner information is required - NOT optional)
Last Name me,,-r; Ig- First Name $f"pheiz 4 KQ4hl' Middle
Street Address ?&/ 15Y AZZ/ S'jee l City /p 74 /'/ins State GD
Phone # 97D -e{93-5-6-yo Email
Name of Business (COMMERCIAL USE ONLY)
Zip S6Sa
CONTRACTOR INFO: Company Name Z 0,-1S r-uc -i o n
License Holder Name T�'� �Gt Ej L n LIC # -D-q7 CERT #
LEGAL INFO:
Subdivision/PUD 4,'e-.-pr-ee17 Filing # Lot # .2 Block # Lot Sq Ft 81-/D D
CONSTRUCTON INFO: total Building Sq Ft (NOT including basement) otal 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 1 /U 41 # of Bedrooms 3 # of Full Baths a
% Baths Yz Baths # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (Rescheck) El SPA Performance SPA Alternative) ❑ Prescriptive❑
Air Conditioning? YES ❑ NO ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas ❑ Electric ❑ Electric Temp. Pedestal
Electric Main Breaker Size (Residential Only): 150 amp or less ❑
ZONING INFO: (COMMERCIAL USE ONLY)
ER[(Energy Rating Index) ❑
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 (including mechanical) associated with the work? Yes ❑ No ❑
If yes, please describe:
Value of Construction (materials and labor): $ o�v'{ 900. "',
Description of Work: el ?LCho1A Ri my ale { 11,V,4e Zewl k
JOBSITE SUPERVISOR CONTACT INFO: Name 'yQ y90 dad elll
SUBCONTRACTOR INFO: Electrical Mechanical
Plumbing i7c cif ��CtM01�24
Fireplace �J
Framing
Solar
Phone
1.Movk%
Roofing
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 (RCM'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 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 J-Ar AQA-t 0
Phone # 970 - G 9a - /S6 Email CZS)9-Zn @ epS ae j /n�zs�/Y�C. 06 iYi
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE