Town of Frederick Permit Number:__________________________
Building Inspections
401 Locust Street - Frederick, CO 80530
Date of Application:_______________________
(720) 382-5605
Inspections: (720) 382-5620 www.frederickco.gov
PLEASE FILL ALL TYPEABLE AREAS IMPORTANT: ENTER ALL DATA NECESSARY FOR A COMPLETE DESCRIPTION OF THE PROJECT
PROPERTY ADDRESS / UNIT # (S) COUNTY LOT(S) BLOCK(S) SUBDIVISION
PROPERTY OWNER OWNERS MAILING ADDRESS PHONE (DAY)
CONTRACTOR NAME OF FIRM CONTACT
EMAIL ADDRESS
TELEPHONE NUMBER
Buil
ding
Electrical
Plumbing
Mechanical
PERMIT TYPE OCCUPANCY CLASS(ES) TYPE OF CONST BUILDING USE: EXISTING____________________ PROPOSED____________________
______________ ____________________ ____________ SPRINKLERED? YES_________ NO______________
Bedrooms Baths Crawl Space Deck Porch Garage Area Living Area (finished)
Setbacks (In Feet) North South East West Basement (Finished) Basement (Unfinished)
No. of Stories Bldg. Height Mezzanine Warehouse Office Other Water Tap Size
DESCRIPTION OF WORK MODEL NO.
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
OPTIONS USED: ______________________________________________________________________________________________________________________________
ELECTRICAL VALUATION (COMM. ONLY) _________________________________________
TOTAL JOB COST ESTIMATE: $________________________________________________ MATERIAL COST ESTIMATE: $________________________________________
(CONTRACTOR VALUE)
NOTICE TO ALL APPLICANTS: TO SCHEDULE AN INSPECTION, CALL (720) 382-5620. THE PERMIT EXPIRES 180 DAYS FROM THE DATE OF ISSUE UNLESS WORK
IS STARTED AND INSPECTIONS HAVE BEEN DONE. BUILDING AND IMPROVEMENTS MUST CONFORM TO THE PLANS SUBMITTED TO THE TOWN. ANY CHANGES
MUST BE APPROVED PRIOR TO CHANGES BEING MADE.
We agree to perform the work described herein in accordance with the For Office Use only
plans and/or specifications submitted. All work done shall be in
compliance with all applicable codes and regulations of the Town of ___________
Frederick, I/we agree that no work would be initiated without this CHECK # Valuation $___________________
application being approved. I/we are aware that any violation of
___________ Permit Fee _________________
applicable codes and regulations can cause revocation of this permit
REC'D BY Plan Review _________________
__________
x
Electrical _________________
SIGNATURE OF APPLICANT
Water Tap Fees:
CWWC Capital Impr.
Frederick Capital Impr.
A
ttach plans, specifications, drawings and other supporting documents. Plot plans CBT Water Share
must be fully dimensional.
Tap Installation
________________
_________________
_________________
_________________
I
mpact Fees:
TOWN APPROVAL General Capital _________________
______________________________________________ Date: _____________________ Park Improvement _________________
SIGNATURE OF OFFICIAL Open Space _________________
Plan Review Notes: Transportation _________________
Drainage _________________
Public Safety Impact _________________
Sales & Use Tax (1.0%) ________________
Sales & Use Tax (2.5%) ________________
Date: _____________________
Planning Sign Off TOTAL FEES $ _________________
Administrative Fee _________________
Construction Meter _________________
GENERAL CONSTRUCTION PERMIT
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signature
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