HomeMy WebLinkAbout1809 ROSEMARY CT - APPLICATIONS - 5/14/2019City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Flirt Collins
281 N. College Ave. •Fort Collins, CO 80524 •Phone: 970.416.2740 • www.fcgov.com/buildine
BUILDING PERMIT APPLICATION
'`2 r-0N OmCE USE
4PPLICATION NUMBER: �r 1� U, 1 APPLICATION DATE:sj . �� n
Job Site Address
PROPERTY OWNER INFO: (All ownerinformation'is required - NOT optional)
Last Name P, c 0 L&, ,. First Name
Street Address van s C_City
Phone # ct 7o- gibl- l 30,r5 mail
Name of Business (COMMERCIAL Use ONLY)
Unit#
�b S}e✓l�a„tee Middle
T—
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CONTRACTOR INFO:
Company Name
Rc� 0A0 U 1
1 ��e u r D �
License Holder Name
(� A �, S _
Kee rk)g
LIC # t?-�37 CERT #
LEGAL INFO:
Subdivision/PUD �0,rk Filing# Lot# Block Lot
-
CONSTRUCTON INFO: Toil Building Sq Ft (NOT including basement)
Residential Sq Ft _)�/ Commercial Sq Ft # of Stories
1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft
Finished Basement Sq Ft
Baths % Baths _
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑
Air Conditioning? YES ❑
# of Bedrooms
# Fireplaces
SPA (Simulated Performance ❑
Alternative)
NO ❑
City of Fort Collins Approved Stock Plan # SPO
Total Garage Sq. Ft.
Bldg Ht # of Dwelling Units
. Unfinished Basement Sq Ft
# of Full Baths
Prescriptive❑ ERI(Energy Rating Index) ❑
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):
Description of Work:
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JOBSITE SUPERVISOR CONTACT INFO: Name `�li,i<< L_ i'.Pvn S Phone Gi7G_c/pZ—/per®
Electrical
Plumbing
Fireplace
Framing
Solar
Mechanical
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 (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: 1 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 G
Phone# q%D-G/p2-/0oo Email
Type or Print Name
t M d -AeM 6--c g
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE