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GARFIELD COUNTY DEPARTMENT OF DEVELOPMENT
BUILDING DIVISION
3rd Floor, Courthouse
100 Bth Street
Glenwood Springs, Colorado 81601
(303) 945-8212
4S779 llWy 6 ;,; 24, GhJnv.uxl Springs JobAddress __ _::_::_:__::_:::::.:'.:___::___::___:::_::_:___::=-::_::_:_:__::~....::.:..;;,..:___: ____________________ _
wilding Permit Natureo!Work ----'=~~~2--~~~~--'--------------------------------
Use of Building _...:Ad=-u::oJ.::c. t::l.(){:'.::. =' ...:to=...:S::!/F..:_...:R.::e:::·s:::i::::l:ol.e.r=-1,_,ce"'··'-------------------------
Owner ----~l'lo.::::b:::ir=-1:....::D~·'---!'l':;::::rel.e~-==s~h,___ _____________________________ _
Contractor ___ K~--'-'-.~!3~·~wal=:'.:t::::er:::__:Coi=~is=t· ~· -------------------------------
Amount of Permit: $ -~3.cl,,,8"--'-. 4,,_5='------------
White -Treas.
Canary -Office
Pink -Applicant
Gold -Duplicate
I.ois J. Butzen ---'---=~-
Clerk
GARFIELD COUNTY
APPLICATION FOR BUILDING PERMIT
PERMIT NUMBER J,¢tJ/
p./ease print or type DATE c. I .asf n
TO BE FILLED OUT BY APPLICANT
--ADDRESS 4S779 ll1j),wq.v q, 4f. 24-
SUBDIVISION '
FILING # LOT # ___ BWCK #
ADDRESS C"£TY
NAME c::-::...LJ'-':'!.l.'--~"'7l~~~~-;)-.4.;U1.;l-~·-~·-
ADDRESS
CITY ~~LI.~"?....1,;otl_.:X'-1-.!;;;.._---------~ Ip HONE ":LL.0..:.-=lLl_:::t_ #
CLASS OF WOPJZ
NEW ALTERATION ____ ADDITION _)(..__ __
DEMOLISH REPAIR MOVE ----MOBILE HOME (make/T'IOdel)
S.F. OF BUILDING 8St> S.E'. OF LOT 0,(p7 Ac•
# OF FLOORS HEIGHT .---..:f'3;..c.' ___ _
# OF FAMILY UNITS # OF BEDROOMS -~z~--
INTENDED USE OF BUILDING //1/i'(!i 1YRt.fers
GARAGE: SlNGLE DBL CARPORT: 75Izf6LE DBL
FIREPLACE
DOCUMENTS ATTACHED
WATER SUPPLY ------------------
DRIVEWAY PERMIT ----'-------------
SITE PLAN -------------------
BUILDING PLANS-----------------
SANITARY SEWER CLEARANCE ------------
ON SITE SEWAGE DISPOSAL PERMIT ---------
OTHER DOCUMENTS (specify)
I
PLOT PLAN
NOTE·: Show easements 1 property line dimensions,
all other structures, specify north, ~nd street
name. For odd shaped lots, or if space is
too smal.1, p.rovide separate plot,lan.
# OF BUILDINGS NOW ON PARCEL --'-~---~-
USE OF BUILDINGS NOW ON PARCEL ;ee;Q""'if?.., ¥
z ,
FRONT PROPERTY LINE
V, .S, .SIX'
STREET NAME/ROAD NUMBER __ [l,""'$~,~tl."-'.2~~h~w~a~y'--'~""-
CHECK IF CORNER LOT
DESCRIPTION OF WORK PLANNED 2 Bednicm)
I .bath aJJ,t/1»1
I hereby acknowledge that I have read this
application and the above is correct and I
agree to comply with all county ordinances
and stat!!._ jws regulatinf building construction.
?~5<.Ya.IJ
SIGNATURE
FOR OFFICE USE ONLY
VALUATION ,OV
PERMIT FEE $ /f._;J,I PLAN CHECK FEE ;:$-L;l...=<!.LL..:.:.......-
TOTAI, FEE $ "i]A. 4-.":.--1JCHOOL IMPACT FEE $ .LJl'..LIL-
DATE PERMIT ISSUED --------------ZONING DISTRICT ~~~:i."J"l=<lft....:..~;;;,"""----------
TYPE OF OCCUPANCY _ _.,,_6!_,_,,.,__L,Z:_____,,'--------
TYPE OF CONSTRUCTION -~f>""'c._~/'-"'~...;_ ________ _
S.F. OF BUILDING &:70 S.F. OF LOT tl,.t,;z,:µ._
MAX. HEIGHT ./'-/)_ ROAD CLASS:.-=-~--
SETBACKS FROM PROPERTY LLNE: FRONT ------
REAR Rl'GHT LEFT -----
OFF STREET PARKING SPACES REQUIRED ------
APPROVED:
FLOOD HAZARD ---------------~
CERTIFIED BLDG ELEVATION ---------~
SPECIAL CONDITIONS -------------
PROBLEMS ~.TITH PERMIT ------------
ADDITIONAL INFORMATION NEEDED --------
CERTIFIED BY COLORADO REGISTERED LAND SURVEYOR
OR ENGINEER -'----------------~