HomeMy WebLinkAbout678 MANSFIELD DR - APPLICATIONS - 4/1/2019City of
Flirt Collins COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
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BUILDING PERMIT APPLICATION
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APPLICATION NUMBER: U APPLICATION DATE: y+ I — 1 1
Job Site Address 0-1 " ^k« �'. Unit#
PROPERTY OWNER INFO: (All owner information is required — NOT optional)
Last Name IY i &OZANAACS First Name F1 M R 1 ANOREA Middle
Street Address -7! MAN)"_- J J , City fb: Iol; -kJ S State _Zip gp--a Zj—
Phone # ���r 9 _,9 (g I Email
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: CompanyName
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License Holder Name � /j
LIC# CERT#
LEGAL INFO:
Subdivision/PUD Filing # Lot # Block # Lot Sq Ft _
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) Tottaall Garage Sq. Ft.
Residential Sq Ft is Commercial Sq Ft # of Stories 1 Bldg Ht 1 J # of Dwelling Units
1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft Unfinished Basement Sq Ft
Finished Basement Sq Ft
% Baths % Baths _
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑
Air Conditioning? YES ❑
# of Bedrooms
# Fireplaces
(Simulated Performance
SPA Alternative) ❑
City of Fort Collins Approved Stock Plan # SPO
# of Full Baths
PrescriptiveM, ERI(Energy Rating Index) ❑
List Option #s
UTILITIES INFO: Gas ❑ Electric (E Electric Temp. Pedestal Yes ❑ No ❑
Electric Main Breaker Size (Residential Only): 150 amp or less (Z 200 Amp ❑ Other ❑
ZONING INFO: (COMMERCIAL USE ONLY)
Proposed Use: (i.e. medical, office, bank, retail, etc.) 0 .;✓; .q, r
For Commercial remodels and tenant finishes, please answer the followins 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 18.
If yes, please describe:
Value of Construction (materials and labor):
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JOBSITE SUPERVISOR CONTACT INFO: Name �;1 ,Phoney
SUBCONTRACTOR INFO: Electrical • l ' Mechanical
�.�i •tom N� x- .+J � r C
Plumbing Framing 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 (ACM's).
1 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 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 requiremAi is contd herein and City of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature e - Type or Print Name
Phone # Q70 -'D 17—.7 J'V-1 Email ,, %� ��� ��„✓ u, �; ,;
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE