HomeMy WebLinkAbout3224GAFIFIELD COUNTY DEPAFITMENT OF DEVELOPlllENT
BUILDING DIVISION
3rd Floor, Courthouse
100 8th Street
Glenwood Sprln{ls, Colorado 81601
(303) 945-8212
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Nature of Work
Use of Buildin91,-,-,--1-~~~~f---61.~!L..e:'.i..--:C:_--------------------------
Owner
Amount of Permit $ _____ 84-j 6!.Ll•-45!->-"---Date:
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White -Treas. --1>~-' J
Canary -Office ~
Pink -Applicant
Clerk
Gold -Duplicate
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GARFIELD COUNTY
APPLICATION FOR BUILDING PERMIT
please print or type
ADDRESS
# ""' < FII,ING # "' ."' TAX SCHEDULE #
""' LEGAL (SEC /TWN /RNG)
00: NAME e~x "' ~ MAILING ADRESS
CITY PHONE -------NAME ~ i'i ~ ADDRES ~"' CITY v J
"' NAME
~ ;:; CITY ·~ PHONE
" # -------
CLASS OF WORK
NEW ALTERATION __ ·V""._ __ ADDITION
DEMOLISH Rf:PAIR MOVE _____ _
MOBILE HOME (make/model)
S,F, OF BUILDJNG /%t!O S.F. OF LOT L·-----
# OF FLOORS ----'-/ ____ HEJGHT _..~ulJ.,_1~~--~--
# OF FAMILY UNITS MIA # OF BEDROOMS ¥/,A
INTENDED USE OF BUILDING ------------
GARAGE: SINGLE DBL CARPORT: SINGLE DBL
FIREPLACE ------------------~
DOCUMENTS ATTACHED
WATER SUPPLY ------------------
DRIVEWAY PERMIT ---------------~
SITE PLAN ------------------~ BUILDING PLANS __ .!'..___ _____________ _
SANITARY SEWER CLEARANCE ------------
ON SITE SEWAGE DISPOSAL PERMJT --~-~---OTH~UM~NTS (specify) 5,'P.tt::thktk,-s
FOR OFFICE
APPROVED:
PLOT PLAN
NOTE: Show easements, property line dimensions,
a11 other structures, specify north, and street
name. For odd shaped lots, or if space is
too smal.1, provide separate plot plan.
# OF BUILDINGS NOW ON PARCEL ---------
USE OF BUILDINGS NOW ON PARCEL --------
FRONT PROPERTY LINE
STREET NAHE/ROAD NUMBER -----------
CHECK IF CORNER LOT
DESCRIPTION OF WORK PLANNED ---------
I hereby acknowledge that I have read this
application and the above is correct and I
agree to comply with all county ordinances
and state laws regulating building construction.
SIGNATURE
USE ONLY
FLOOD HAZARD ---~~--~----~~~~
CERTIFIED BLDG ELEVATION -~-------~
SPECIAL CONDITIONS ~-----~~~---~
PROBLEMS WITH PERMIT -~-~~~~~-~~~
ADDITIONAL INFORMATION NEEDED --------
CERTIFIED BY COLORADO REGISTERED LAND SURVEYOR
OR ENGINEER ~~------~~~~~~~~-
APPROVED:-'--~~~-------~~~~---
PLANNING DEPARTMENT DATE