HomeMy WebLinkAbout3235 MOORE LN - APPLICATIONS - 4/23/2019City of
,N r Collins
COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION -
OFFICE R)I OFFIUSE -' I i '• ��
PPLICATION NUMBER: APPLICATION DATE: .- s
Job Site Address
owner information is required — NOT
Last Name
First Name --�/np/I
Street Addressp6me,
Z6 City (a /
Phone # gDRI
Email Llp�
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Co/jWy Name
S ku
I
License Holder Name
LEGAL INFO:
Subdivision/PUD
Filing # Lot #
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement)
Residential Sq FtCommercial Sq
_
Ft # of Stories_
1st Floor Sq Ft 2nd Floor Sq Ft
3rd Floor Sq Ft
Finished Basement Sq Ft
# of Bedrooms
Baths % Baths
# Fireplaces
ENERGY INFORMATION: (CHECK ONE)
Unit#
Middle
_State Zip
LIC# L)=5gii CERT#
Block # Lot Sq Ft
Total Garage Sq. Ft.
Bldg Ht # of Dwelling Units
Unfinished Basement Sq Ft
# of Full Baths
ComCheck ❑ UA (ResCheck) ❑ SPA (Simulated Performance ❑ Prescriptive❑
Alternative)
Air Conditioning? YES ❑ NO ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s
ERI(Energy Rating Index) ❑
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. alease 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:
JOBSITE SUPERVISOR CONTACT INFO: Name
SUBCONTRACTOR INFO: Electrical n
Plumbing LRT� �CC�ccj Framing
Fireplace
Solar
R
Phone q'70-yg�- �a:�
Mechanical 0&j-k j4 � s-
T'
Roofing KY—�r�,s--
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 (ACM's).
I
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 requireme ontained herein nd City of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature ki A Type or P`rin_t(-Name
Phone# 1-�t{`�� ���j Email �S6GG_ -U `-5t uc�jn>�� CQAA
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE