HomeMy WebLinkAboutApplication- PermitGarfield County
Building & Sanitation Department
108 81h Street, Suite #201 Glenwood Springs, Co. 81601
Office- 945-8212 Inspection Line- 384-5003 /n/ 6 iyPa Jen
Job Address 0 9 8 i2J2 (9 7 '
Nature of Work Building Permit (3 17 62 - X3,3 -0/ -006i,
NO. Cir1��
Use of Building
//f piecing (C�9Q Q4
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Owner 1
Contractor ( )ts�tlet�
Amount of Permit S S000 • 9 C Date
Clerk
4.
Permit No:
GARFIELD COUNTY BUILDING PERMIT APPLICATION
108 8'° Street, Suite 201, Glenwood Springs, CO 81601
Phone: 970-945-8212/ Fax: 970-384-3470 / Inspection Line: 970-384-5003
ParceVSchedule No:I79 0.23-1 -Ob ,
AGREEMENT
PERMISSION 1S HEREBY GRANTED TO THE APPLICANT AS OWNER. CONTRACTOR AND/OR THE AGENT OF THE CONTRACTOR OR OWNER TO CONSTRUCT
THE STRUCTURE AS DETAILED ON PLANS AND SPECIFICATIONS SUBMITTED TO AND REVIEWED BY THE BUILDING DEPARTMENT.
IN CONSIDERATION OF THE 1SSSUANCE OF THIS PERMIT, THE SIGNER. HEREBY AGREES TO COMPLY WITH ALL BUILDING CODES AND LAND USE
REGULATIONS ADOPTED BY GARFIELD COUNTY PURSUANT TO AUTHORITY GIVEN IN 3038.201 CRS AS AMENDED. THE SIGNER FURTHER AGREES THAT
IF THE ABOVE SAID ORDINANCES ARE NOT FULLY COMPILED WITH IN THE LCOATION, ERECTION, CONSTRUCTION, AND USE OF THE ABOVE DESCRIBED
STRUCTURE, THE PERMIT MAY BE REVOKED BY NOTICE FROM THE COUNTY AND THAT THEN AND THERE IT SHALL BECOME NULL AND VOID.
THE ISSUANCE OF A PERMT BASED UPON PLANS, SPECIFICATIONS AND OTHER DATA SHALL NOT PREVENT THE BUILDING OFFICIAL FROM THEREAFTER
REQUIRING THE CORRECTION OF ERRORS IN SAID PLANS, SPECIFICATIONS AND OTHER DATA OR FROM PREVENTING BUILDING OPERATION BEING
CARRIED ON THEREUNDER WHEN IN VIOLATION OF THS CODE OR ANY OTHER ORDINANCE OR REGULATION OF THIS JURISDICTION.
THE REVIEW OF SUBMITTED PLANS AND SPECIFICATIONS AND INSPECTIONS CONDUCTED THEREAFTER DOES NOT CONSTITUTE AN ACCEPTANCE OF
ANY RESPONSIBILITIES OR LIABLITIES BY GARFIELD COUNTY FOR ERRORS, OMISSIONS OR DISCREPENCIES. THE RESPONSIBILITY FOR THESE ITEMS
AND IMPLEMENTATION DURING CONSTRUCTION RESTS SPECIFICIALLY WITH THE ARTICTECT, DESIGNER, BUILDER, AND OWNER. COMMENTS ARE
INTENDED TO BE CONSERVATIVE AND IN SUPPORT OF THE OWNERS INTEREST.
Garfo®.003
I HEREBYCKNOWLEDGE THAT 1 HAVE READ AND UNDERSTAND THE AGREEMENT ABOVE (INITIAL):
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Job Add ress:rpn3 ^� 12(,-1 PO -a
p( l gi a
1 Lot No: Y Block No: N/df Subd. /(EExemptionnfrwe � J
l�
Yee htl')
%103 ` J.
2
Owner:
Owner:
�f i!�
Address/t
ee ,9I+A Sill-
Ph:
g7Xtu.
3
3
Contractor: ^
42
`
Address:
Ph:
Ic. No.
4
Architect/707F
Address:
Ph:
Lic. No.
5
Sq. Ft. of Building: /J O.26 .
•0 _
Sq. Ft. of Lot: ..3.
Height:
No. of Floors: 1
6
Use of Building: . . ' / it / ^ .% - _I(, n�� •f Q )
7
/ /�
Describe 'ork: J / �G 6,.J. .J li/H.EE&Oa1affS))4-It yorrYi�Ci�jySJ-Mcreroocr-A acit�'
8
Class of Work: bc New1 ❑ Alteration ❑ Remove
o Addition o Move
9
10
Garage: jst.. Single
o Double
Carport: ❑ Single
o Double
)Driveway Perini n o On -Site Sewage Disposal o Site Plan
,ytA)"U N.Q,EOIa 1 -Jail 045 (Septic)
11
Valuation of Work: $iD — /� coo
coo
Adjusted Valuations: $ /
g 1 2 Oe cp
12
Special Conditions:
NOTICE
A SEPARATE ELECTRICAL PERMIT IS REQUIRED AND MUST BE
ISSUED BY THE STATE OF COLORADO.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR, IF
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A
PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS
APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL
PROVISIONS OF LAWS GOVERNING THIS TYPE OF WORK WILL BE
COMPLETED WITHIN WHETHER SPECIFIED HEREIN OR NOT. THE
GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY
TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR
LOCA REGULATING INSTRUCTION OR T.' PERFORMANCE
OFC '; 'UC^ON.
�j�—_ ist
Plan Check Fee:
I99 7/
Permit Fee:
707. ?i/
Total Fee: 11! Dated Permit Issued:
5—C)(10 , Q/
(P•'•
OCC GrO_ Bpm/ Const. Type:
"'r�I/t/��x
Zoning:
Setbacks:
Manu. Home: ISDS No. & Fee:
5
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BLDG D;141•�
APPRO 'In DATE "'
a J 1 t.H
/
AGREEMENT
PERMISSION 1S HEREBY GRANTED TO THE APPLICANT AS OWNER. CONTRACTOR AND/OR THE AGENT OF THE CONTRACTOR OR OWNER TO CONSTRUCT
THE STRUCTURE AS DETAILED ON PLANS AND SPECIFICATIONS SUBMITTED TO AND REVIEWED BY THE BUILDING DEPARTMENT.
IN CONSIDERATION OF THE 1SSSUANCE OF THIS PERMIT, THE SIGNER. HEREBY AGREES TO COMPLY WITH ALL BUILDING CODES AND LAND USE
REGULATIONS ADOPTED BY GARFIELD COUNTY PURSUANT TO AUTHORITY GIVEN IN 3038.201 CRS AS AMENDED. THE SIGNER FURTHER AGREES THAT
IF THE ABOVE SAID ORDINANCES ARE NOT FULLY COMPILED WITH IN THE LCOATION, ERECTION, CONSTRUCTION, AND USE OF THE ABOVE DESCRIBED
STRUCTURE, THE PERMIT MAY BE REVOKED BY NOTICE FROM THE COUNTY AND THAT THEN AND THERE IT SHALL BECOME NULL AND VOID.
THE ISSUANCE OF A PERMT BASED UPON PLANS, SPECIFICATIONS AND OTHER DATA SHALL NOT PREVENT THE BUILDING OFFICIAL FROM THEREAFTER
REQUIRING THE CORRECTION OF ERRORS IN SAID PLANS, SPECIFICATIONS AND OTHER DATA OR FROM PREVENTING BUILDING OPERATION BEING
CARRIED ON THEREUNDER WHEN IN VIOLATION OF THS CODE OR ANY OTHER ORDINANCE OR REGULATION OF THIS JURISDICTION.
THE REVIEW OF SUBMITTED PLANS AND SPECIFICATIONS AND INSPECTIONS CONDUCTED THEREAFTER DOES NOT CONSTITUTE AN ACCEPTANCE OF
ANY RESPONSIBILITIES OR LIABLITIES BY GARFIELD COUNTY FOR ERRORS, OMISSIONS OR DISCREPENCIES. THE RESPONSIBILITY FOR THESE ITEMS
AND IMPLEMENTATION DURING CONSTRUCTION RESTS SPECIFICIALLY WITH THE ARTICTECT, DESIGNER, BUILDER, AND OWNER. COMMENTS ARE
INTENDED TO BE CONSERVATIVE AND IN SUPPORT OF THE OWNERS INTEREST.
Garfo®.003
I HEREBYCKNOWLEDGE THAT 1 HAVE READ AND UNDERSTAND THE AGREEMENT ABOVE (INITIAL):
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The following items are required by Garfield County for a final inspection:
1. A final Electrical Inspection from the Colorado State Electrical Inspector;
2. Permanent address assigned by Garfield County Building Department posted where readily
visible from access road;
3. A finished roof, a lockable house, complete exterior siding, exterior doors and windows
installed, a complete kitchen with cabinets, a sink with hot & cold running water, non-absorbent
kitchen floor coverings, counter tops and finished walls, ready for stove and refrigerator, all
necessary plumbing;
4. All bathrooms must be complete, with washbowl, tub or shower, toilet stool, hot and cold
running water, non-absorbent floors and walls finished and a privacy door;
5. All steps outside or inside over three (3) steps must have handrails, guard rails on balconies or
decks over 30" high constructed to all IBC and IRC requirements;
6. Outside grading done to where water will detour away from the building;
7. Exceptions to the outside steps, decks and grading may be made upon the demonstration of
extenuating circumstances, i.e. weather, but a Certificate of Occupancy will not be issued until
all the required items are completed and a final inspection made;
8. A final inspection sign off by the Garfield County Road & Bridge Department for driveway
installation, where applicable; as well as any final sign off by the Fire District, and/or State
Agencies where applicable.
A CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUED UNTIL ALL THE
ABOVE ITEMS HAVE BEEN COMPLETED.
****CANNOT OCCUPY OR USE DWELLING UNTIL A CERTIFICATE OF OCCUPANCY
(C.O.) IS ISSUED. OCCUPANCY OR USE OF DWELLING WITHOUT A C.O. WILL BE
CONSIDERED AN ILLEGAL OCCUPANCY AND MAY BE GROUNDS FOR VACATING
PREMISES UNTIL ABOVE CONDITIONS ARE MET.
I understand and agree to abide by the above conditions for occupancy. pse and th ssuance of a
Certificate of Occupancy for the dwelling under building permit # �C�/�
Signature
BpcontOct2004
Date
FFA ESTIMATE
FINISHED LIVING SPACE: X 74.68 =
UNFINISHED BASEMENT: X 41.00 =
CRAWL SPACE: - X 9.00 =
GARAGE: /Dar) X18.00 = /f es
UNCOVERED PATIO/DECK: 12.00 =
COVERED PATIO/DECK: X 24.00 =
MISC.
MISC.
TOTAL VALUATION: /�,_3� 0 L"
PLAN REVIEW FEE: l 7 71
PERMIT FEE:
TOTAL:
536 , 9
MANUFACTURED HOME SET UP FEE:
SEPTIC - PERMIT:
PERK:
•
Plans must include a floor plan, a concrete footing and foundation plan, elevations all sides with
decks, balcony, steps, hand rails and guard rails, windows and doors, including the finish grade line
and original grade. A section showing in detail, from the bottom of the footing to the top of the roof,
including re -bar, anchor bolts, pressure treated plates, floor joists, wall studs and spacing, insulation,
sheeting, house -rap, (which is required), siding or any approved building material. Engineered
foundations may be required.
A window schedule. A door schedule. A floor framing plan, a roof framing plan, roof must be
designed to withstand a 40 pound per square foot up to 7,000 feet in elevation, a 90 M.P.H. wind
speed, wind exposure B or C, and a 36 inch frost depth. -
All sheets to be identified by number and indexed. All of the above requirements must be met or
your plans will be returned.
All plans submitted must be incompliance with the 2003 IRC.
1. Is a site plan included that identifies the location of the proposed structure or addition and
distances to the property lines from each corner of the proposed structure(s) prepared by a
licensed surveyor and has the surveyors signature and professional stamp on the drawing?
Properties with slopes of 30% or greater must be shown on the site plan. (NOTE
Section: 106.2) Any site plan for the placement of any portion of a structure within 50 ft.
of a property line and not within a previously surveyed building envelope on a
subdivision final plat shall be prepared by a licensed surveyor and have the surveyor's
signature and professional stamp on the drawing. Any structure to be built within a
building envelope of a lot shown on a recorded subdivision plat shall include a copy of
the buildin nvelope as it is shown on the final plat with the proposed structure located
within t envelope.
Yes
2. Does the site plan also include any other buildings on the property, setback easements and
utility easements? Please refer to Section 5.05.03 in the Garfield County Zoning Resolution
if the prop you are applying for a building permit on is located on a corner lot. Special
setbacks apply.
Yes
3. Does the site plan include when applicable the location of the I.S.D.S. (Individual Sewage
Disposal System) and the distances to the property lines, wells (on subject property and
adjacegtroperties), streams or water courses?
Yes
2
4. Does the site plan indicate the location and direction of the County or private road accessing
the property,
Yes
5. Do the plans include a foundation plan indicating the size, location and spacing of all
reinforcing1 ' accordance with the IRC or per stamped engineered design?
Yes-- �d7
6. Do the plans indicate the location and size of ventilation openings for under floor crawl
spaces and the clearances required between wood and earth?
Yes IN P,
7. Do the plans indicate the size and location of ventilation openings for the attic, roof joist
spaces andets?
Yes
8. Do the plans include design loads as required by Garfield County for roof snow loads, (a
minimum of 4 unds per square foot up to & including 7,000 feet above sea level), floor
loads and d loads?
Yes
Rk9
9. Does the plan include a building section drawing indicating foundation, wall, floor, and roof
construct on?
Yes
10. Does the building section drawing include size and spacing of floor joists, wall studs, ceiling
joists, root joists or trusses?
Yes
11. Does the building section drawing or other detail include the method of positive connection of
all columifs and beams?
Yes V S
12. Does the elevation plan indicate the height of the building or proposed addition from the
undisturbed grade to the midpoint between the ridge and eave of a gable or shed roof or the
top of a (Building height measurement usually not to exceed 25 feet)
Yes ✓
13. Does the plan include any stove or zero clearance fireplace planned for installation including
make and model and Colorado Pis II certifications or phase II EPA certification?
Yes No
3
14. Does the plan include a masonry fireplace including a fireplace section indicating design to
comply with the IRC?
Yes No VMI S
15. Does the plan include a window schedule or other verification that egress/rescue windows
from sleeping rooms and/or ba$meentts comply with the requirements of the IRC?
Yes No V
16. Does the plan include a window schedule or other verification that windows provide natural
light and ventilation for all habitable rooms?
Yes (til`S No
17. Do the plans indicate the location of glazing subject to human impact such as glass doors,
glazing immediately adjacent to such doors; glazing adjacent to any surface normally used as
a walking surface; sliding glass doors; fixed glass panels; shower doors and tub enclosures
and specify safety glazing for thept�e's?
Yes No V
18. Is the location of all natural and liquid petroleum gas furnaces, boilers and water heaters
indicated on the plan?
Yes
No Y
19. Do you understand that if you are building on a parcel of land created by the exemption
e subdivision process, are building plans in compliance with all plat notes and/or
process o
coven
Yes
No
20. Do you understand that if you belong to a homeowners association, it is your responsibility
to obtain written permission from the association, if required by that association, prior to
submitting an application for a building permit? The building permit application will not
be accept wi out it.
Yes I t No
21. Will this be the only residential structure on the parcel?
Yes No if no -Explain:
22. Have tw
Yes
lete sets of construction drawings been submitted with the application?
23. Do you understand that the minimum dimension a home can be on a lot is 20ft.wide and 20ft.
long?
Yes V O -C" No
4
t
24. Have you designed or had this plan designed while considering building and other
constru ion code requirements?
Yes M S No
25. Do your plans comply with all zoning rules and regulations in the County related to your
propertie zofrstrict?
Yes t/w No
26. Does the lan accurately indicate what you intend to construct and what will receive a final
inspects n by the Garfield County Building Department?
Yes S No
27. Do yo derstand that approval for design and/or construction changes are required prior to
the a lication of these changes?
Yes No
28. Do you understand that the Building Department will collect a "Plan Review" fee from you
at the time of application submittal and that you will be required to pay the "Permit Fee" as
well as any "Road Impact" or "Septic System" fees required, at the time you pick up your
buildin ermit?
Yes , / I A l No
29. Are you aware that you must call in for an inspection by 3:30 the business day before
the requested inspection in order to receive it the following business day? Inspections
will be made from 7:30 a.m. to 3:30 p.m. Monday through Friday. Inspections are to be
called ' to 384-5003.
Yes hl 1 L No
30. Are you aware that requesting inspections on work that is not ready or not accessible will
result in a 0.9Q0 re -inspection fee?
Yes I 11 AGJ No
31. Are you aware that you are required to call for all inspections required under the IRC
including approval on a final inspection prior to receiving a Certificate of Occupancy and
occupan of the building?
Yes JAQ—, No
32. Are you aware that the Permit Application must be signed by the Owner or a written
authori being given for an Agent and that the party responsible for the project must comply
with th IRC?
Ye
33. Are you aware that prior to submittal of a building permit application you are required to
show proof of a driveway access permit or obtain a statement from the Garfield County Road
& Bridge Department stating one is not necessary? You can contact the Road & Bridge
Departm•e1� �t 625-8601.
Yes W� No
34. Do you understand that you will be required to hire a State of Colorado Licensed Electrician
and Plumber to perform installations and hookups, unless you as the homeowner are
performing the work? The license number of the person performing the work will be
required eft time�Iof applicable inspection.
IAJ�
Yes
No
35. Are you aware, that on the front of the Building Permit Application you will need to fill in
the Parc Schedule Number for the lot you are applying for this permit on prior to submittal
of a bu. ding permit application? Your attention in this is appreciated.
Yes `7 No
36. Do you know that the local f e district„may require you to submit plans for their review of
fire safety issues? Yes Vh� 5 No (please check with the
building department about this requirement)
37. Do you understand that if you are planning on doing any excavating or grading to the
property prior to issuance of a building permit that you will be required to obtain a grading
permit?
Yes
I hereby acknowledge that I have read, understand and answered these questions to the
t of my abilit
Si ' nat, e of Owner
q� g7(P..aoy
Phone: f 7O 174,cb 0 (days);
(evenings)
Project Name: (7Afllbi
Project Address:_ q oe rQ/g 71,
6
Notes: If you have answered "No” on any of the questions, you may be required to provide this
information at the request of the Building Official prior to beginning the plan review process. Delays
in issuing the permit are to be expected. Work may not proceed without the issuance of a permit. If
it is determined by the Building Official that additional information is necessary to review the
application and plans to determine minimum compliance with the adopted codes, the application
6
April 20, 2005
Michele Soet
0923 CR 218
Silt, CO 81652
CGarfield County
Garfield County Road and Bridge Department
CC: Garfield County Building and Planning Department
Dear Ms. Soet
You do not need a driveway permit from the Garfield County Road and Bridge Department,
as your driveway does not access a maintained county toad.
If you have any questions or problems, please feel free to contact me.
Sincerely,
Kraig Kuberry/Ted Morgan
District 2 Foreman/Equipment Operator 2
Garfield County Road and Bridge Department
P.O. Box 426
Rifle, CO 81650
Phone: 970-625-8601
Fax: 970-625-8627
De Garfield County
Date: g -//-o 6
To:
92 C/ a /ff
-8.e.4 do 8/6-<-2
Dear Permit Holder,
BUILDING & PLANNING DEPARTMENT
Code Compliance Office
Please refer to your building permit number 9516. issued 4/--,,a;---,05:
A routine review of our open building permits indicates that we have not received a request for an inspection
on this permit since /2
Please be advised that building permits expire. per Uniform Building Code. section 106.4.4 and International
Code Section 105.5. "Every permit issued by the building official under the provisions of this code shall
expire by limitation and become null and void if the building or work authorized by such permit is not
commenced within 180 days from the date of such permit, or if the building or wort authorized by such
permit is suspended or abandoned at any time after the work has commenced for a period of 180 days.
Before such work can be recommenced, a new permit shall first be obtained to do so. and the fee therefore
shall be one half the amount required for a new permit for such work. provided no changes have been made
or will be made in the original plans and specifications for such work, and provided further that such
suspension or abandonment has not exceeded one year. In order to renew action on a permit after expiration,
the permittee shall pay a new full permit fee."
Please contact this office at your very earliest convenience, in writing, to advise us about the status of your
permitted work.
If you have not responded within thirty days from the receipt of this notice the permit will be closed
and a permanent notation will be placed in the property records at the County Clerk and Recorders
office that indicates that the work permitted per Colorado Revised Statutes 30-28.205 & 210, was not
inspected. is not approved and that the building or area is illegal to occupy and is subject to legal
abatement action.
Thank you for your cooperation.
Sincerely, ,2 etar,/ /lam'
Tun Holliday
Dave Mead
Matt Provost
Building Inspectors
108 8th Street, Suite 201, Glenwood Springs. Colorado 81601
(970) 945-8212 (970) 285-7972 Fax: (970) 384-3470
No. Assessor's Parcel No 9/79"r,R 3 )f -
1A5e„rkk- . e-
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BUILDING PERMIT CARD ,42.'•x'/
Job Address (J(1&3 l f P O ) o i fl1- tri
�Glate`i ,�,- i CSS encs
r v,
Phone #Ct ic�X`Y`
Owner rej, rntr G lE i4 Address .c
-.
Address Phone #(Qt c) X1,35 3
Contractor c_it--E-A_QC--
Setbacks: Front Rear RH
EAlr INSPECTIONS
Soils Test
Footing S"/D-of !OS --
Foundation �' 11 -OS park
Grout
Underground Plumbing
Rough Plumbing
Framing f-Z-OSOwi
Insulation S- IS -04, 83m
Roofing
Drywall S- IS -0(3 cot
Gas Piping /-
5'-/y of Crk, tf 97z�64
y"ie irxa ole/C2.- er-
o'� r
NOTES
LH Zoning ? 76 -cR55C7 41 -
Weatherproofing Weatherproofing
Mechanical
Electrical Rough (State) 9/414.9, 3-3/-06
Electri al Fina} ( tate) E -az a -G6 t>
Final/�2Z heck isf t Completed'
Certificate Occupancy #
Date
Septic System #
Date
Final
Other
(continue on back)
INSPECTION WILL NOT BE MADE UNLESS
THIS CARD IS POSTED ON THE JOB
24 HOURS NOTICE REQUIRED FOR INSPECTIONS
Ji
BUILDING PERMIT
GARFIELD�COUNTY, COLORADO if
Date Issue WIQ ,Zoned Area Permit No
AGREEMENT
In consideration of the issuance of this permit, the applicant hereby agrees to comply with all
laws and regulations related to the zoning, location; construction and erection of the proposed
structure for which this permit is granted, and further agrees that if the above said regulations
are not fully complied with in the zoning, location, erection and construction of the above
described structure, the permit may then be revoked by notice from the County Building
Ins or and IMMEDIATELY
BECOME Ti1LL AND VOID/
sal U
Use "rc3 — l/
Address orriptio
Owner
Setbacks
i
Front
Contractor Q tarddn—r
Side Side Rear
This Card Must Be Posted So It is Plainly Visible From The Street Until Final Inspection.
INSPECTION RECORD
Footing yJ°-d5iQ t ntnc
Driveway
Foundation s p.,$_. p ki tc
N 11-
Underground Plumbing n)"
Insulation 5_75_ 0 b,Qyt
Rough Plumbing ,1
Drywall 6„/6 -_oh y(
Chimney & Vent a
Electric Final (by State los�rl �)f3%ti A
Gas PipingFinal
II - 14, p(P icivk
Electric Rough (By State Inspector); c c
Septic Final NA
Framing /2 -2—O5
(To include Roof in place and Windows
and Doors installed).
Notes:
ALL LISTED ITEMS MUST BE INSPECTED AND APPROVED BEFORE COVERING -
WHETHER INTERIOR OR EXTERIOR, UNDERGROUND OR ABOVE GROUND.
THIS PERMIT IS NOT TRANSFERABLE
For Inspections Call 384-5003 108 8th Street Glenwood Springs, Colorado
DO NOT DESTROY THIS CARD
APPROVED
Date 7/ J4. 17 By r(3J
IF PLACED OUTBID - COVER WITH CLEAR PLASTIC
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