HomeMy WebLinkAbout3876 � � GARFIELD COUNTY
APPLICATION FOR BUILDING PERMIT � /
PERMIT NUMBER r�j
please print or type DATE I3 90
TO BE FILLED OUT BY APPLICANT PLOT PLAN
ADDRESS M3' it "21bNnast frca. __ _ NOTE: Show easements, property line dimensions,
SUBDIVISION 3Atxtlra.1Y.tL VILL4Gt all other structures, specify north, and street
V FILING # i LOT # 7 3 BLOCK # 15'.. name. For odd shaped lots, or if space is
TAX SCHEDULE # too small, provide separate plot plan.
LEGAL (SKC /TWN /RNG) # OF BUILDINGS NOW ON PARCEL
W NAME t5Awtftgzir ,,,, &r4 pAy flag
USE OF BUILDINGS NOW ON PARCEL
MAILING ADDRESS 'f?,p, D'v$ as
O CITY ,w7LEweir M aAPHONE L -I?are
NAME
1 E ADDRESS al AI ' CITY n ydaEc
c NAME C e rr ea f s Op.am Ca .
g ADDRESS S 4 Air
CITY ' S 4 A
8 PHONE 24 g".. fl, LICENSE #
CLASS OF WORK 5 1
NEW 7e ALTERATION ADDITION ). L
DEMOLISH REPAIR MOVE 4
MOBILE HOME (make /model)
S.F. OF BUILDING S.F. OF LOT
# OF FLOORS HEIGHT
# OF FAMILY UNITS # OF BEDROOMS
INTENDED USE OF BUILDING CACAGr 4- PtUL.0
GARAGE: SINGLE DEL CARPORT: SINGLE DBL FRONT PROPERTY LINE
FIRiPLACE
DOCUMENTS ATTACHED _ STREET NAME /ROAD NUMBER
WATER SUPPLY CHECK IF CORNER LOT _
DRIVEWAY PERMIT A/ nb er b /G r 2 e) DESCRIPTION OF WORK PLANNED kn,� ,A
SITE PLAN Pe' 4m.
BUILDING PLANS ,#qAc.el• Pe7fOr
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 coy,• ith all county ordinances
F4.4 / "-"" +av and —Le la^- regula % ng bu ding construction
SIGNATUI /
Ili FOR OFFICE USE ONLY
VALUATION A Q O FLOOD HAZARD
PERMIT FEE $ m.8'0 PLAN CHECK FEE $ /,S, ° a CERTIFIED BLDG ELEVATION
TOTAL FEE $,y'q'50 SCHOOL IMPACT FEE $ SPECIAL CONDITIONS
DATE PERMIT ISSUED
ZONING DISTRICT PROBLEMS WITH PERMIT
TYPE OF OCCUPANCY JVJ
TYPE OF CONSTRUCTION P!j,g7flq ADDITIONAL INFORMATION NEEDED
S.F. OF BUILDING in 0 S.F. OF LOT 5
MAX HEIGHT )09-1*— ROAD CLASS. CERTIFIED BY COLORADO REGISTERED LAND SURVEYOR
SETBACKS FROM PROPERTY LINE: FRONT __ OR ENGINEER
REAR RIGHT LEFT
OFF STREET PARKING SPACES REQUIRED �
APPROVED: Gg._/I r-,,� .._ • 't, APPROVED: /i7
"`
:UILDING DEPARTMEN ✓ I DA PLANNING DEPARTMENT DATE
1