HomeMy WebLinkAbout1133 BENT TREE CT - APPLICATIONS - 9/14/2020City of COMMUNITY DEVELOPMENT & NEIGHBORHOOD SERVICES
Fort Collin
281 N. College Ave. •Fort Collins, CO 80524 •Phone: 970.416.2740 • www.fceov.cam/building
BUILDING PERMIT APPLICATION
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APPLICATION NUMBER: IS�1Y17{ UI I'Ij\vr` vi/=lll> I// APPLICATION DATE:
Job Site Address 113 �e,h± Tre e (� Unit#
PROPERTY OWNER INFO: (All owner information is required - NOT optional)
Last Name �7 115 1�� First NameMiddle Q
Street Address &,vt4 T(ae a , City 5FLO CjjA.5 State Cb Zip W6-4y—
Phone # S73- a lflC)(_pr Email 11- 6�- •
Name Of Business (COMMERCIAL USE ONLY)
CONTRACTOR INFO: Company Name
License Holder Name LIC # CERT #
LEGAL INFO: Il , Lebo
Subdivision/PUD Filing # -ff # �yyBlock # Lot Sq Ft j-�
CONSTRUCTON INFO: Total Building Sq Ft (NOT including basement) Total Garage Sq. Ft. (-(�
Residential Sq FtCommercial Sq Ft (, _# of StoriesBldg Ht # of Dwelling Units_
1st Floor Sq Ft 2nd Floor Sq Ft 3rd Floor Sq Ft _Unfinished Basement Sq Ft
Finished Basement Sq Ft 5-bib # of Bedrooms # of Full Baths
3/ Baths % Baths �_ # Fireplaces
ENERGY INFORMATION: (CHECK ONE)
COmCheCk ❑ UA (ResCheck) ❑ SPA(Simulated Performance ❑ Prescriptive[]ERI(Energy Rating Index) El
Alternative)
Air Conditioning? YES A NO ❑
City of Fort Collins Approved Stock Plan # SPO List Option #s
UTILITIES INFO: Gas Q Electric Q Electric Temp. Pedestal Yes ❑ No1
Electric Main Breaker Size (Residential Only): 150 amp or less 3` 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 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 .,El
If yes, please describe:
Value of Construction (materials and labor):
Description of Work:
P A
JOBSITE SUPERVISOR CONTACT INFO: Name
1\® ti
pp I AG
Phone
SUBCONTRACTOR INFO: Electrical (/) Mechanical
Plumbing Framing Roofing
Fireplace 219 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 (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 1 have read this application and state that the above information is correct and agree to
comply with all requirements contained her in and City of Fort Collins ordinances and state laws regulating building construction.
Applicant Signature Type or Print Name
Phone# S —� Email �C�m( � 4-L" rk�
THIS APPLICATION EXPIRES 280 DAYS FROM APPLICATION DATE