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} GARFIELD COUNTY
APPLICATION FOR BUILDING PERMIT
PERMIT NUME R .s y ,e
AZ print or type DATE r /
TO BE FILLED OUT BY APPLICANT PLOT PLAN
ADDRESS (/' 0* A4 - NOTE:. Show easements, property line dimensions,
.a SUBDIVISION ai .~ %f / //Q 9 a all other structures, specify north, and street
4 FILING # LOT # / BLACK # /1 name. For odd shaped lots, or if space is
• TAX SCHEDULE # too small, provide separate plot plan.
LEGAL (SEC /TWN /RNG) # OF 'BUILDINGS NOW ON PARCEL Afp.✓g'
W NAME Co #-rt Las 2-6A �""'e'Se USE OF BUILDINGS NOW ON .PARCEL
o MAILING ADDRESS to Bob (p(.90
CITY B/�rttsrur�< ssk PHONE 285 - 9i0$
1 a NAME s prwE
e E ADDRESS CITY
a NAME soµ, '�
I ADDRESS
CITY
8 PHONE LICENSE #
U
CLASS OF WORK
NEW 1../ ALTERATION ADDITION
DEMOLISH REPAIR MOVE
MOBILE HOME (make/model) 1 i r
S.F. OF BUILDING S.F. 506'5 OF LOT ,
# OF FLOORS HEIGHT .�. /�,r
# OF FAMILY UNITS / # Q BEDRROO S c � Z
INTENDED USE OF BUILDING t ee -s a--
GARAGE: SINGLE DBE CARPORT: SINGLE DEL FRONT PROPERTY LINE
FIREPLACE /L/O
4 �
DOCUMENTS ATTACHED STREET NAME /ROAD NUMBER at nmo Cet.dc.
WATER SUPPLY ..y: iI CHECK IF CORNER LOT L
DRIVEWAY PERMIT DESCRIPTION OF WORK PLANNED
SITE PLAN A„ e t
BUILDING PLANS !�' n A - a
SANITARY SEWER CLEARANCE "16,4/1 C. -- . - 9_0 I hereby acknowledge that I have read this
ON SITE SEWAGE DISPOSAL PERMIT .-v application and the above is correct and I
OTHER DOCUMETS (specify) agree to comply with all county ordinances
4 and s laws reg t ng building construction
1 URE
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! FOR OFFICE USE ONLY
VALUATION - 5'7 3 S. co FLOOD HAZARD
PERMIT FEE $ 4(„p PLAN CHECK FEE $ 7D CERTIFIED BLDG ELEVATION
TOTAL FEE $ 7. 2_tl SCHOOL IMPACT FEE $ SPECIAL CONDITIONS
DATE PERMIT ISSUED
ZONING DISTRICT /Pitt) PROBLEMS WITH PERMIT
TYPE OF OCCUPANCY lRA J !1
TYPE OF CONSTRUCTION ..A., A 4444.; te. 4..w..,e ADDITIONAL INFORMATION NEEDED
S.F. OF BUILDING 3 S.F. OF LOT (1.7,900 S s
MAX. HEIGHT ..--k. it_ ROAD CLASS. CERTIFIED BY COLORADO REGISTERED LAND SURVEYOR
SETBACKS FROM PROPERTY LINE: FRONT OR ENGINEER .
REAR RIGHT LE T _
OFF STREET PARKING SPACES REQUIRED
APPROVED: /Gr e _ .J/ .a.t r. - (3 cde APPROVED: Q
d ILDING DEPARTMEN . DA' PLANNIN D RTMENT TE