2004-05-26_REVISION - M1991083

• Permit No: M1991083
• IBM Index Class Name: Revision
• Doc Date: 5/26/2004
• Doc Name: Conversion Appl
• From: Seifert Construction
• To: DMG
• Type & Sequence: CN1
• Media Type: D
• Archive: No

-3-
ter.
(Wane. cad phone of acme to be uxd w permit)
CaoucYa Nattte: Jerald A. Seifert Tick: Sole Proprietor
~~,Name: Seifert Construction
~p U. Box: 198 Range View Loop p.o. Box: 305
city: Westcliffe
state:
Tekphoa N®ber.
FaNrml~
Colorado ~~ 81252
( .719 ~ _ 783-2757
( 719 ~- 783-2988
(if different from appliomt/opaatar above)
CaataoPsNama Joe Ga~liano Tice: Consultant
~yN~: LJ DEVELOPMENT INC.
Streer/P.O. Box:
City:
slam:
Telephate Number:
FaxNumber:
Caotaot'a Nante:
Campmy Name:
Snnet/P.O. Bmc
city:
Srue:
Tdephooe Number:
Fax Nrmrba:
I59 TiflPaay CT P.O. Box:
Pueblo
Colorado zip code: 81005
( 719 ~ _ 240-9424
( 719 ~ _ 583-0788
Kent Beach ~,~. Manager
Seifert Construction
198 Range View Loon p,p, Box: P.0. BOX 305
Westcliffe
Colorado zp code: 81252
~ 719 ~ _ 783-2757
~ 719 ~ _ 783-2988
M• ~'!'ATEORFEDFRA~L~-i~I1[~R+t~R(dsmrl
~9. COLORADO STATE LAND BOARD / contact Mark Davis
~; 1313 Sherman Street RM 819
city: Denver
state: Colorado zip cone: 80203
TekpLooe Number. (303 ~ - 886-3751 office phone: [phone]
rr~ QTaTFnRFI?pF~Tter.rA~?~OWNF.R(ifaml
Agm,,y. SEE ABOVE
sheet:
City:
State: ~P ~:
Tekphme Numbs: ( 1-