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APPLICATION FOR BUILDING PERMIT
PERMIT NUMBER e/
please print or type DATE /0/1 0
TO BE FILLED OUT BY APPLICANT PLOT PLAN
ADDRESS 2113 Odin Drive NOTE: Show easements, property line dimensions,
a SUBDIVISION Asgard all other structures, specify north, and street
d 0 ____ FILING # 2rd LOT # 4B BLOCK # name. For odd shaped lots, or if space is
a TAX SCHEDULE 0 _ too small, provide separate plot plan.
LEGAL (SEC /TWN /RNG) # OF BUILDINGS NOW ON PARCEL
w NAME W yre & Mary Odell. USE OF BUILDINGS NOW ON PARCEL
n' MAILING ADDRESS P. O. Box 91.31 See Plot Plan Attached
N CITY Silt PRONE 87 6.2y65
i w NAME
E ADDRESS _ CITY
NAME sass as above
I ADDRESS
CITY
8 PHONE LICENSE 0
CLASS OF WORK
NEW ALTERATION ADDITION 7IX
DEMOLISH _ REPAIR MOVE
MOBILE HOME (make /model)
S.F. OF BUILDING 1442.4 S.F. OF LOT 5 acres +
# OF FLOORS 1 HEIGHT bir
# OF FAMILY UNITS _ # OF BEDROOMS
INTENDED USE OF BUILDING
GARAGE: SINGLEX DBL CARPORT: SINGLE DBL FRONT PROPERTY LINE
FIREPLACE
DOCUMENTS ATTACHED _ STREET NAME /ROAD NUMBER
WATER SUPPLY CHECK IF CORNER LOT _
DRIVEWAY PERMIT DESCRIPTION OF WORK PLANNED
SITE PLAN x
BUILDING PLANS X 5 pages
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 a county ordinances
an. scat; laws re•r`� building construction
/ al
SIGNATURE
FOR OFFICE USE, ONLY
VALUATION s 4. Ha G ,o 0 FLOOD HAZARD
PERMIT FEE $S,4„5"0 PLAN CHECK FEE $ ?a, R /) _ CERTIFIED BLDG ELEVATION
TOTAL FEE $ y3,f/) SCHOOL IMPACT FEE $ SPECIAL CONDITIONS
DATE PERMIT ISSUED
ZONING DISTRICT PROBLEMS WITH PERMIT
TYPE OF OCCUPANCY /V/.
TYPE OF CONSTRUCTION VA/ ADDITIONAL INFORMATION NEEDED
S.F. OF BUILDING 4,8 Q S.F. OF LOT neat
MAX. HEIGHT AI .3. --. ROAD CLASS. ,+77',4ct CERTIFIED BY COLORADO REGISTERED LAND SURVEYOR
SETBACKS FROM PROPERTY LINE: FRONT 4 ..(jr a -f- + OR ENGINEER . _
REAR RIGHT LEFT
OFF STREET PARKING SPACES REQUIRED %�+ /fC��F�,!
APPROVED4;7
I /// � / / /.itiv� 101
g' / APPROVED: J .�- YA'�^� l�/ // L
DG DEPA T NT aATE PLANNIN D PARTMENT / Ii ATE