HomeMy WebLinkAbout923 PIONEER AVE - APPLICATIONS - 4/22/2020FitCity of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Collins, 281 N. College Ave. • Fort Collins, CO 80524 • Phone: 970.416.2740 • www.fcgov.com/building
BUILDING PERMIT APPLICATION
/l // FOR OFFICE USE
PPLICATION NUMBER:�ZC V 3b %� APPLICATION DATE: _
Job Site Address I G 3 R,� Ave- . Unit#
PROPERTY OWNER INFO: (All owner information is required - NOT optional)
Last Name Is �A� First Name G26G Middle G, —
Street Address �� ?,_dam"ir_- Vc- State _Zip puJ L1
Phone'# �2(� —3(c Email _� H� 4M2 rOM
Name of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name f f k'
License Holder Name
LIC # CERT #
LEGALINFO:
Subdivision/PUD (I ((?� Filing # Z,, d Lot # qj�, Block # Lot Sq Ft 0 4S
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) SOv Total Garage Sq. Ft.
Residential Sq Ft/I 62�46 Commercial Sq Ft # of Stories / Bldg Ht # of Dwelling Units )
1st Floor Sq Ft I 2nd Floor Sq Ft 3rd Floor Sq Ft
Finished Basement Sq Ft ._! `+h # of Bedrooms
% Baths % Baths # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
ComCheck ❑ UA (ResCheck) ❑
NA
Air Conditioning? YES ❑
(Simulated Performance
SPA ❑
Alternative)
City of Fort Collins Approved Stock Plan # SPO
Unfinished Basement Sq Ft
# of Full Baths Y
Fe,,,JJ Ar.e,, ti $DO 57
-iux,ad aw ti ( (o s r
Prescriptive[] ERI(Energy Rating Index) ❑
List Option #s
UTILITIES INFO: Gas Ia Electric X Electric Temp. Pedestal Yes ❑ No ❑
Electric Main Breaker Size (Residential Only): 150 amp or less `8 200 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): $ �"if dG �i
Description of Work: -V j C L &F,- ,'-P iAA J o — ; JA Ai n � I-SIA L' nr_ M Avt—
JOBSITE SUPERVISOR CONTACT INFO: Name
SUBCONTRACTOR INFO: Electrical tC�Y-C,,,50," {fi r; Mechanical
Phone
Plumbing C-OV &ya,J fl�mb �q Framing Roofing
Fireplace Solar Other
ASBESTOS STATEMENT DISCLOSURE: In accordance with the State of Colorado Senate Bill 13-151, property owners, applying for a
remodel permit, shall indicate their awareness about their property having been inspected forAsbestos Containing Materials (ACM'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
Phone# Email 426k6W
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE