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APPLICATION FOR BUILDING PERMIT
417/34PERMITNUMBER
please print or type DATE nil
TO BE FILLED OUT BY APPLICANT PLOT PLAN
ADDRESS Is C s NOTE:. Show easements, property line dimensions,
SUBDIVISION 5'nG, y,all other structures, specify north, and street
FILING #LOT # t BLOCK # 2_,name. For odd shaped lots, or if space is
TAX SCHEDULE #too small, provide separate plot plan.
LEGAL (SEC/TWN/RNG)11 OF BUILDINGS NOW ON PARCEL 0
x NAME USS OF BUILDINGS NOW ON PARCEL a /,p_
MAILING ADDRESS 'F?p Lnno
o CITY q PHONE
at NAME AIAT'i— Pi< n &Li g T
ADDRESS CITY
a NAME' T.M Fe 4 y.,,, Ff
ADDRESS s ,}w
g CITY SA- ^"-E
PHONE LET s- -43 LICENSE #
CLASS OF WORK
S c 1-1
NEW ALTERATION ADDITION
DEMOLISH REPAIR MOVE
MOBILE HOME (make /model)wL
S.F. OF BUILDING vo S.F, OF LOT 6 ,
OF FLOORS 1 HEIGHT
OF FAMILY UNITS 1 OF BEDROOMS 3
INTENDED USE OF BUILDING p,- 17.4 w lei
GARAGE: SINGLE DBL— CARPORT: SINGLE DBL
FRONT PROPERTY LINEFIREPLACE
DOCUMENTS ATTACHED STREET NAME /ROAD NUMBER ea CIRCL.e
WATER SUPPLY C=24 Sn., e CHECK IF CORNER LOT
DRIVEWAY PERMIT 1. p,,DESCRIPTION OF WORK PLANNED attab
SITE PLAN An5 - r44F -r.7r, r , Abr.
BUILDING PLANS o,v Fn..r oar-sin ,.
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 ordi'ances
and state law 7.417thing e ildfng jonstruction .
iaVK ,
oQ l Ah#LSc = 1 oQc co SIGNATUR
FOR OFFICE USE ONLY
VALUATION a /ac FLOOD HAZARD
PERMIT FEE $ 7'!',$Th PLANCHECKFEE $ /07 - o CERTIFIED BLDG ELEVATION
TOTAL FEE f,5 SCHOOL IMPACT FEE $ V{.SPECIAL CONDITIONS
DATE PERMIT ISSUED
ZONING DISTRICT J LI /PROBLEMS WITH PERMIT
TYPE OF OCCUPANCY 1
TYPE OF CONSTRUCTION y C $' 5'r ADDITIONAL INFORMATION NEEDED
S.F. OF BUILDING /6. 7 S.F. OF Lel'
MAX. HEIGHT 1—/4— ROAD CLASS, CERTIFIED BY COLORADO REGISTERED LAND SURVEYOR
SETBACKS FROM PROPERTY LINE: FRONT OR ENGINEER
REAR RIGHT LEFT
OFF STREET PARKING SPACES REQUIRED
APPROVED: iit i J L p a APPROVED: —. .z ' /o'Y' 7t
e %'IL,DING DEPARTME T ' DAT=PLACATING DEPT • E' DATE