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GARFIELI) COUNTY
APPLICATION FOR BUILDING PERMIT gaol
/ ` PERMIT NUMBER tt
please print ax type DATE S ' 0 1
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TO BE FILLED OUT BY APPLICANT PLOT PLAN
ADDRESS GKOT A' O _I >Q NOTE: Show easements, property line dimensions,
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SUBDIVISION Ki c S l_� all other structures, specify north, and street
FILING # LOT # _ ifs BLOCK # name. For odd shaped lots, or if space is
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E TAX SCHEDULE # too small, provide .separate plot plan.
LEGAL (SEC /TWN /RNG) # OP BUILDINGS' NOW ON PARCEL ; Qf
- •----- USE OF BUILDINGS NOW ON PARCEL
W NAME , -, ' r m h
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R I MAILING ADDRESS el ). -7� Sj,[ P� (i'T � R^��
p CITY 5 l,✓m la- Cal PFloNE 47(p3 -dyt/'7
NAME -- �..`..._�_ �...._..
1 4 ,ADDRESS — CITY T
a NAME QC)PW—t AA .c..-
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- ADDRESS
Y a N CITY ( t, &,etn JAL/n-÷. , I
o PHONE 1 7JW- LICENSE #
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CLASS OF WORK W �
NEW k ALTERATION ADDITION
DEMOLISH REPAIR MOVE I
MOBILE IIOME (make /model)
S.F. OF BUILDING 190() S.F. OF LOT
# OF FLOORS a- HEIGHT
# OF FAMILY UNITS # OF BEDROOMS 3
INTENDED USE OF BUILDING � Potirl y /lif, 4 .4 -c.L_
GARAGE: SINGLE DBL x CARPORT: SINGLE'_ DAL FRONT PROPERTY LINE
FIREPLACE -Z1,1„.0 'tL 4.41 - ,.
_ DOCUMENTS ATTACHED STREET NAME /ROAD NUMBER &, bIw ✓4 /K�L[tAoa/pn.
WATER SUPPLY (SQk./LV,,t.. I j t_:� ,_ CHECK IF CORNER LOT _X_____
DRIVEWAY PERMIT L "
- DESCRIPTION OF WORK PLANNED A•Lt..." abtrn.4/cni'_
SITE PLAN .-C
BUILDING PLANS
SANITARY SEWER CLEARANCE d N T hereby acknowledge that I have read this
ON SITE SEWAGE DISPOSAL PERMIT .] 4/C application and the above is correct and I
OTHER DOCUMENTS (specify) _ agree to comply with all county ordinances
and state ,.w regulating building construction
?IPIo °,f /N. - � ya w. �� AP-9 1
- s � SIG 'NATU'E�
,{� FOR OFFICE USE ONLY
VAL UAT pp O ` CC / 7 g'! 4. , on FLOOD HAZARD P .'RMI FeE-', AN CHEC FEE $ . pf',21 CERTIFIED BLDG ELEVATION mm
TOTAL FEE $ SCHOOL IMPACT FEE'.$ --T SPECIAL CONDITIONS
DATE PERMIT SS7 ED ?Wing
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,;,ZONING
.DISTRICT /VA iie ^ ) PROBLEMS WITH PERMIT
'TYPE OF OCCUPANCY K ,j
TYPE OF CONSTRUCTION X 47: - ADDITIONAL .INFORMATION NEEDED
S.F. OF BUILDING 7 *7,p ,,p S.F. OF LOT 5.2 AL
A MAX. HEIGHT ROAD CLASS. .CERTIFIED BY COLORADO REGISTERED LAND SURVEYOR
SETBACKS FROM PROPERTY LINE: FRONT jii r---`--- OR ENGINEER
REAR 24r RIGHT 4,/ _ LEFT /[)/
OFF STREET PARKING SPACES REQUIRED
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APPROVE D �� !�,., AP PROVED : /.,_,_ '� - ir ,
RUIrnING DEPARTME; Or D. L PLANNING DEPARTME- DATE