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GARPIELD COUNTY
APPLICATION FOR BUILDING PERMIT GG 7
PERMIT NUMBER 76 J
please print or type DATE �3/G,d
TO BE PILLED OUT BY APPLICANT PLOT PLAN 111
ADDRESS (2:53 PA m44 f g. NOTE: Show easements, property line dimensions,
SUBDIVISION PANARA MA RAfCHgS all other structures, specify north, and street
FILING # LOT # (Q BLOCK # name. For odd shaped lots, or if space is
TAX SCHEDULE # too small, provide separate plot plan.
LEGAL (SEC /TWV /RNG) Ste 17T,75, # OF BUILDINGS NOW ON PARCEL
cE NAME + =� G N USE OF BUILDINGS NOW ON PARCEL
y MAILING ADDRESS f2334'AH424MAPQ4
p CITY Cf( ONDRI.F 011.4) PHONE
--- NAME LIW.izy( 24jetra uen1.P r
ADDRESSa/1 i4 yDv pR. CITY Ca vppU
g NAME L A W S / Zu65CNwoR.O t
t ADDRESS 054 HANDY DC
CITY QJ4130.1v4W.0 CGOM/4000
PHONE 9h3 -2207 LICENSE #
V
CLASS OF WORK
NEW )0 ALTERATION 54 ADDITION X
DEMOLISH REPAIR MOVE
MOBILE HOME (make /model)
S.F. OF BUILDING ,124 S.F. OF LOT 7.99 AG+
# OF FLOORS i HEIGHT / /Leo"
# OF FAMILY UNITS # OF BEDROOMS
INTENDED USE OF BUILDING jAUNDRY V' iM ADDITION
GARAGE: SINGLE DBL SINGLE CARPORT: SINGL DBL
_ T FRONT PROPERTY LINE
FIREPLACE
DOCUMENTS ATTACKED STREET NAME /ROAD NUMBER
WATER SUPPLY CHECK IF CORNER LOT
DRIVEWAY PERMIT DESCRIPTION OF WORK V PLANNED
SITE PLAN i V/✓da &60n7 A17D /r /d/t
BUILDING PLANS /
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) agree to comply with all county ordinances
and state laws regulating building construction
SIGNATURE
//��
FOR OFFICE USE ONLY
VALUATIONA /, 20t), s n FLOOD HAZARD
PERMIT FEE $A -0,fn , PLAN CHECK FEE $ ` j Q 3 CERTIFIED BLDG ELEVATION
TOTAL FEE $53,?(") SCHOOL IMPACT FEE $ SPECIAL CONDITIONS
DATE PERMIT ISSUED
ZONING DISTRICT PROBLEMS WITH PERMIT
TYPE OF OCCUPANCY /{ 3. ,
TYPE OF CONSTRUCTION �/ ,/, ADDITIONAL INFORMATION NEEDED
S.F. OF BUILDING Ja0 ' S.F. OF LOT p7
MAX. HEIGHT //' .-�-� ROAD CLASS. kTT4c CERTIFIED BY COLORADO REGISTERED LAND SURVEYOR
SETBACKS FROM PROPERTY LINE: FRONT OR ENGINEER .
REAR RIGHT LEFT
OFF STREET PARKING SPACES REQUIRED
APPROVE .� " 4 - ! APPROVED: 3 , 4 fr
BUILDING DEPARTMENT DATE PLAN�PARTMENT DATE