HomeMy WebLinkAbout3407 GARFIELD COUNTY
Mti APPLICATION FOR BUILDING PERMIT / kr
PERMIT NUMBER
please print or type DATE 4/9
TO BE FILLED OUT BY APPLICANT PLOT PLAN
ADDRESS 6720X3 115 1,/,,,xq 4 fli/ NOTE: Show easements, property line dimensions,
SUBDIVISION all other structures, specify north, and street
FILING # LOT # BLOCK # name. For odd shaped lots, or if space is
TAX SCHEDULE # too small, provide separate plot plan.
LEGAL (SEC /TW,V /RNG) # OF BUILDINGS NOW ON PARCEL
USE OF BUILDINGS NOW ON PARCEL
NAME ..c.. ) t
MAILING ADDRESS 20 � -
o CITY G e r
Wm', PHONE ' 4 s t FD�
x NAME .r ` ► /��`` r1 1" Gj
E ADDRESS ` �7 CITY /` „f
a NAME /�' /
U ADDRESS
g CITY
a PHONE LICENSE #
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CLASS OF WORK
NEW ALTERATION f ADDITION
DEMOLISH - REPAIR MOVE
MOBILE HOME (make /model)
S.F. OF BUILDING S.F. OF LOT
# OF FLOORS HEIGHT
# OF FAMILY UNITS # OF BEDROOMS
INTENDED USE OF BUILDING
GARAGE: SINGLE DBE CARPORT: SINGLE DBL
FRONT PROPERTY LINF,
FIREPLACE 6 DOCUMENTS ATTACHED STREET NAME /ROAD NUMBER 6D[a 7 9' t1- 6 q y
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WATER SUPPLY a 7 CHECK IF CORNER LOT _
DRIVEWAY PERMIT 11 DESCRIPTION OF WORK PLANNED
SITE PLAN 11 �
BUILDING PLANS _ - - - ,. '. Atli"- 'j it
SANITARY SEWER CLEARANCE ,t1x /S i I hereby acknowledge that I have read this
ON SITE SEWAGE DISPOSAL PERMIT application and the above is correct and I
OTHER DOCUMENTS (specify) agree to comply with all county ordinances
and state laws regulating building construction
S5aa
SIGNATURE
FOR OFFICE USE ONLY
VALUATION -�W FLOOD HAZARD
PERMIT FEE $ fl,CQ PLAN CHECK FEE $ .� 2-s8C7 CERTIFIED BLDG ELEVATION
TOTAL FEE X33,3 0 SCHOOL IMPACT FEE $ N0}-- SPECIAL CONDITIONS
DATE PERMIT ISSUED /_
ZONING DISTRICT _ /Da r.k PROBLEMS WITH PERMIT
TYPE OF OCCUPANCY
TYPE OF CONSTRUCTION V fY ADDITIONAL INFORMATION NEEDED
S.F. OF BUILDING h- 3/ S.F. OF LOT
MAX. HEIGHT --7/1 r _ ROAD CLASS. --- CERTIFIED BY COLORADO REGISTERED LAND SURVEYOR
SETBACKS FROM PR PERTY LINE: FRONT OR ENGINEER n
REAR RIGHT LEFT f11Ffinww 1 3 6 . 44 ,_ ^ iw Con 4 K ('Gz4,
OFF STREET PARKING SPACES REQUIRED
APPR.� , ✓./i. �''r / 5'D i �'C.� /' ,,
BUILDING iEPARTMENT / DR PLANNING DEPA R TMENT DA E