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Gørfield Cou nty Communtty Derelopment Deperùnnt tOg g* Strêet, Sühe ¿{lt Gþnuþod Sprlq¡, CO &S{n [970194$3212 www.rarfi eld-counhr.com I have read üe abo¡eandhæpfq,idedürerequircdat#furbtmaüonïùkùb correct and best of mY lmouledge. z z-z- Date à) SIGN PERMIT APPUCANON FORM 3 o?- (o?/ /,**Lr-(- ç ,L ¿zr <-SqMA ¡ N gVt' be-fLg . Gty:ç Øu 9 tt¿o I Owner/Applkant MailingAddress: tame: b äpcch: BtQzSUJ ãpGode: Ptpne:t fn 7o?-6?tt Mailing Adress: tfr 4-r¡c_1,ht¡u rxÊCity: ReprsentatÌre (Autf¡oñratkn Reç¡¡red! ilarne:IL rrl¿-9\tu¿+rt m L 9 ¡*t n in tgwt t-2t<sLÇ - Z3î -Vota -7ot -oo1 Øz-- 7q sr (r,) esscssol's Paræl llumben (sq.ftl:s¡gn Hdgñt: nE rLU'l4b't >i 9r I'L (ro"', Same Prìopertt æ üe Assoc¡ad Bustpss Zoæ District: tr li¡gn b lllur$naæd do*b t¡cated onürc PhÌ,s¡caystreet Addryss: ftsÍ ¡ltcft¡üttild$rtaËopccddterenderhgplan,deÞ¡led $ll t'l'lbe ?",1iWAÞ€ rZloZlz Pl.rro¡{ Lt Appranal oaæ:J 2 ' 3' Zozl- IL-7Permit ftumber: Signed Permit Fee: {S2s+$l pÊr ddel ?. oo squarcfudof sün area Per gFFl€lAt usE oNtY '1zt z .T