HomeMy WebLinkAbout3270GAFIFll'LD COUNTY Dl'PAFITMl'NT OF Dl'VELOPMl'NT
. BUILDING DIVISION
3rd Floor,.Courfhouae
100 81h Blreol
Ol•nwDOd Springe, Colorado 81601
(303) 9415-8212
" .. f. , ~.) <"'; :'·.~
Job Address ----=11::;6:;... · .... ~=· ·=· =""'·91,y'"""'~-_,· llPlll=· =IQlll'l=::;t,,._,V_,,,i=ll.a=ge""-_-...,Pa@.chu=""""""'te,,,,...._.Co""""l,.,or"'""'do""'--------
Nirture of Work JIAdition oftflllllily :roan and sh:lp
use of Building ____ sing_=-l_e_f_mm_'_l_,,_y_reai.dence __ ~· _ _.('"""eld.---'e'-'ting=-.=..cl.__ ______________ _
Owner __ ..._ ____ Oavid ___ R_._·'lbnder ___________________ --'----------
Contractor ____ ....Jll!Ilal::..._--'-------------'------------------
Amountof Permit $ __ _.2,.8,,8"._,_7..,5 ______ _
Pemdt l!'ee , • , , • , • , .175.00
Plan Check Fee ,,, •• 113.75
White -Treas.
canary ·Office
Pink· Applicant
Gold -Duplicate
Patr1 ci a .Tones
Clerk
..•.
·-' GARFIELD COUNTY
APPLICATION FOR BUILDING PERMIT
PERMIT NUMBER -------
please print or type DATE <f .:TIA.;\/" ,?''
TO BE FILLED OUT BY APPLICANT
ADDRESS //(._}fa_J_g'-"'00 W<Cl)!_
SUBDIVISION Ato,; I/In e11-T' II )/JM; 'i
FILING # LOT # ft2__ BLOCK #
TAX SCHEDULE #
LEGAL (SEC/TWN/RNG) __________ _
O<: NAME ....!!~!....!'..L.J.L~.::-,.._t,~~~~~-~--~ MAILING ADDRESS ) 6 ofet.110{) i.JQ
o cITY PA hcHu Te PHONE ~trJW
-NAME ..s !1111~ Fs o 1<-;;~ C ~ ~ ADDRESS CITY _____ _
ADDRESS ------------------
CITY -------------------
[PHONE ------LICENSE # -------
CLASS OF WORK
NEW ALTERATION ADDITION
DEMOLISH REPAIR MOV!!: ----------
MOBILE HOME (make/PJOdel"'
S .P. OF BUILDING 7ff l_ S .F. OF DOT
# OF FLOORS HEIGHT --------
# OF FAMILY UNITS # OF BEDROOMS ----
INTENDED USE OF BUILDING JfAt1t l} V /f(JiJfll cj, S /IQf
GARAGE: SINGLE_ DBL~ CARPOR1': 'BINGLE_ DBL
FIREPLACE Jf;,(t'< I,~,,
DOi]!)MENTS A;TACHED
WATER SUPPLY ------------------
DRIVEWAY PERMIT ----------------
SITE PLAN -------------------
BUILDING PLANS-----------------
SANITARY SEWER CLEARANCE -------------
ON SITE SEWAGE DISPOSAL PERMIT ________ _
OTHER DOCUMENTS (specify)
PLOT PLAN
NOTE: slww easements, property line dimensions,
all-other structur~s, specify north, and street
:name. For odd shaped lots, or if space is
too sma.1.1, provide separate plot plan.
# OF' BUILDINGS NOW ON PARCEL _ _./2.,_.'/2.,_,t:..=-----
USE OF BUILDINGS NOW ON FARCE~
9hj w FR4J./?e '&L,.tqr:e..
FRONT PROPERTY LINE
STREET NAME/ROAD NUMBER -----------CHECK IF' CORNER LOT
DFSCRIPTION OF WORK PLANNED ---------
I hereby acknowledge that I have read this
applioation and the above is correot and I
agree to comply with all county ordinances
and state laws regulating building construotion.
SIGNATURE
FOR OFFICE USE ONLY
APPROVED:
FLQOD HAZARD ----------------
CERTIFIED BLDG ELEVATION ----------
SPECIAL CONDITIONS ~-----------~
PROBLEMS WITH PERMIT ------------
ADDITIONAL INFORMATION NEEDED _______ _
CERTIFIED BY COLORADO REGISTERED LAND SURVEYOR
OR ENGINEER -----------------
DATE