HomeMy WebLinkAbout3460 .% s
• GARFIELD COUNTY
APPLICATION FOR BUILDING PERMIT `� O
PERMIT NUMBER If
please print or type DATE /6/13/77
TO BE FILLED OUT BY APPLICANT PLOT PLAN
ADDRESS 41/4 /1 .J--5 NOTE; Show easements, property line dimensions,
SUBDIVISION all other structures, specify north, and street
4 • FILING # LOT # BLOCK # name. For odd shaped lots, or if space is
W • TAX SCHEDULE # )/t5 - 02.3 - 0v - 051 too small, provide separate plot plan.
LEGAL (SEC /TWN /RNG) 2 w 4 - # OF BUILDINGS NOW ON PARCEL
• NAME / L. � �,� r USE OF BUILDINGS NOW ON PARCEL ,Q erec1t1 c t
W MAILING ADDRESS S j t =4'I
• CITY C7 PHONE
NAME
ADDRESS �� CITY
NAME __lLy�cc ✓[�
P ADDRESS
CITY �'- S
8 PHONE LICENSE #
V
CLASS OF WORK
NEW ALTERATION ADDITION
DEMOLISH _ REPAIR MOVE
MOBILE HOME (make /model) AA+
S.F. OF BUILDING S.F. OF LOT
# OF FLOORS / HEIGHT / L -
# OF FAMILY UNITS NA- # OF BEDROOMS /v 4
INTENDED USE OF BUILDING a a' /-GC of e_
GARAGE: SINGLE VDBL CARPORT: SINGLE DBL FRONT PROPERTY LINE
FIREPLACE 4/ ar - `
DOCUMENTS ATTACHED STREET NAME /ROAD NUMBER , tt-h p/ S (A-c "�'
WATER SUPPLY /I/'A CHECK IF CORNER LOT
DRIVEWAY PERMIT 'Vey DESCRIPTION OF WORK PLANNED renr /ice cf
SITE PLAN 4,..„.„ SgO 7. cde .dUfa
BUILDING PLANS .4sa s _
SANITARY SEWER CLEARANCE I hereby acknowledge that I have read this
ON SITE SEWAGE DISPOSAL PERMIT application and the above is correct and I
OTHER DOCUMENTS (specify) fi agree to comply with all county ordinances
and state laws rating building construction
UMW 4:17
� • �11' SIGNAT R 6t 6' "
FOR IFFICE USE ONLY
VALUATION 04 °Gc0, FLOOD HAZARD _
PERMIT FEE $ -5¢ PLAN CHECK FEE $ q O CERTIFIED BLDG ELEVATION
TOTAL FEE $ 7? ¢p SCHOOL IMPACT FEE $ A. SPECIAL CONDITIONS
DATE PERMIT ISSUED
ZONING DISTRICT ;JPL'.,T.;�•ia PROBLEMS WITH PERMIT
TYPE OF OCCUPANCY
TYPE OF CONSTRUCTION _ ADDITIONAL INFORMATION NEEDED
S.F. OF BUILDING - 1 ✓ p S.F. OF LOT
MAX. HEIGHT -l„ / y ROAD CLASS. 4" CERTIFIED BY COLORADO REGISTERED LAND SURVEYOR
SETBACKS FROM PROPERTY LINE: FRONT e @ OR ENGINEER .
REAR RIGHT LEFT
OFF STREET PARKING SPACES REQUIRED
41.44)esat �
APPROVED: � / /1fL4d i1 ., �� ✓ r ' 7 Aaaamei 7 A 1 i _ -!' 1144--- / D
ILDING DEPAR M NT sr 0- E PLANNING DEPARTMENT D TE