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APPLICATION FOR BUILDING PERMIT 74 ��
PERMIT NUMBER 0
please print or type DATE (Apr i 1 a4�
TO BE FILLED OUT BY APPLICANT PLOT PLAN
ADDRESS 0 — 61( a!bSO NOTE: Show easements, property line dimensions,
a .SUBDIVISION all other structures, specify north, and street
< FILING # LOT # BLOCK # — name - For odd shaped lots, or if space is
o
w TAX SCHEDULE # too small, provide separate plot plan.
LEGAL (SEC /TWV /RNG) # OF BUILDINGS NOW ON PARCEL
- USE OF BUILDINGS NOW ON PARCEL /9
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c x° PHONE LICENSE # •/ - 5
CLASS OF WORK -
NEW )4 ALTERATION ADDITION
DEMOLISH REPAIR MOVE
MOBILE HOME (make /model) 'V
S.F. OF BUILDING 14W) S.F. OF LOT ,c_cuL 73'S� -e #
# 01' FLOORS HEIGHT
# OF FAMILY UNITS # OF BEDROOMS 3 .2 (0 (ZC1.
INTENDED USE OF BUILDING LA. u Son 0)
GARAGE.: SINGLE DBL CARPORT: SINGLE DBI. T FRONT PROPERTY LINE
FIREPLACE
DO ATTACNED _ STREET NAME /ROAD NUMBER 2752 per
WATER SUPPLY C- 6/P-// CHECK IF CORNER LOT _
DRIVEWAY PERMIT 2 1 1-7 4 1/›.7 DESCRIPTION OF WORK PLANNED / r13 /744(.3r, SITE PLAN ,/- 8 8 /5 X 1
BUILDING PLANS L+-
SANITARY SEWER CLEARANCE I hereby acknowledge that I have road this
ON SITE SEWAGE DISPOSAL PERMIT / /it efrfru application and the above is correct and I
OTHER DOCUMENTS (specify) 70 3 agree to comply with all county ordinances
and state laws regulating building construction
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SIGNATUR
>' FOR OFFICE USE ONLY
5 .0, 00
VALUATION FLOOD HAZARD
PERMIT FEE $ 27 ,S WEAN CHECK FEE $ CERTIFIED BLDG ELEVATION
TOTAL FEE $ ,- SCHOOL .IMPACT PEE $ SPECIAL CONDITIONS
DATE PERMIT ISSUED �_
ZONING DISTRICT' /- -� PROBLEMS WITH PERMIT
TYPE OF OCCUPANCY 3
TYPE OF CONSTRUCTION V— N ADDITIONAL INFORMATION NEEDED
S.F. OF BUILDING 4 0 S.F. Or LOT 5 — 6t c-
MAX• HEIGHT ,/L- ROAD CLASS. y ` CERTIFIED BY COLORADO REGISTERED LAND SURVEYOR
SETBACKS FROM PROPERTY LINE: FRONT I— OR ENGINEER .
REAR RIGHT LEFT
OPE STREET PARKING SPACES REQUIRED
AP
/lii -77 I
APPROVED: /i,� � , / �� � • APPRDVED:
_ DING DE'ARTMEN or DA.E PLANNING DEPARTMENT DAT •