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<br />BUILDING. PERMIT AFPLl~saTION <br />N 0 <br />° i <br />ti ~ <br />D C <br />' COUNTY OF ADAMS ~ ~({~g~T , <br />450 SOUTH 4TH AVENUE BRIGHTON, COLORADO 8D601 C <br /> 659-2120 ' <br />Complete Numbered Lines - PRINT <br />JOB AODR ESS l ~ 1 c`i ~ ~ ~ '~ LOT ~ i BLOCK OR TRACT <br /> <br />SUBDIVISION 1 ~~ r ~ ! ~ CENSUS TRACT <br />_ j~ _ <br />1 _ ~ 'i ~ ~_ t/ <br />LEGAL DESCRIPTION ~ ! r <br /> <br />Setbacks from ~ - ,r <br />4 Proxrty Lln(s ~ ~ N S E ^'~ _i _~ ~ W <br /> <br />OWNER ^'•, - .'T MAIL ADDRESS 99 ZIP ' PHONE <br />~ )i-r ! :'L/. I`<C Cn~i <br />'I !i r`u Yr•, r. 'f .27` [Ccl^ :ic.! ~/ %r vri~ i.'`?_ i7~ <br />GONTR.L.TOR MAIL ADDRESS PHCNE LICENSE NO. <br /> <br /> <br />ARCHITECT OR DESIGNER MAIL ADDRESS PHONE LICENSE NO. <br /> <br />ENGINc..4 ~ ~ MAIL ADDR F55 PHONE LICENSE NO. <br /> <br />PLUMBING CONTRKTOR ~ MAIL ADDAE55 BRANCH <br />9 <br />ELECTRICAL CDNTRACTOR <br />10 . .. . <br />USE OF duILDInG OR IMPROVEMENT <br />~~ <br />~ <br />I Ownership: ^ PriVdte <br />11 .~,_ ..: r ~ ~' d .~ c / ~ . 4 l.~.. , . ~ ^ Public <br />z °x <br />N <br />1 <br />N <br />a >. <br />l ' <br />i <br />F <br />c =- <br />N <br />m <br />m I T <br />~ 12 Class d work: NEW ~ ^ ADDITION ^ ALTERATION ^ REPAIR ~ MOVE ^ P.EMOVE ~ I~: <br />.13 Describe Work: /1 n 'y _ ~ i <br />. ,~ ~ -f. ~ _ . ~ . <br />?.~ ~ J ! <br />14 Change of Use From' To ~ ~~ <br />TYPE OF ~ I TYPE OF ~ ^ PUBLIC TYPE OF ^ PUBLIC <br />HEATING FUEL SEWAGE DISPOSAL ^ PRIVATE WATEP. SUPPLY ~ PRIVATE <br />15 Valuation of Work: 5 <br />r~ ,~ o d Type of <br />Const Occupancy <br />Group Size of Bldg. <br />I Rotal) SC. F[. - <br />SPECIAL CONDITIONS: ~ ,, Fire , No. of ~ Maz. <br />~ <br />~ <br />} .- ~~~~ Zone Stories Occ. Load <br />~ <br />( <br />-T 1 "~'•-•--""` No. o} <br />Dwelling Units Number of <br />Bedrooms NI umber of <br />I Bathrooms <br />I <br />y Fire Sprinklers OFFSTREET PAR KING SPACES <br /> <br />' <br />Required ^ Yes ^ No I <br />Covered : <br />Uncovered <br />' NOTICE <br />THIS PERN,IT BECQM ES NULL AND VOID IF WORK CR CONSTRUG <br />Special Approvals <br />Required -~- --~--~~-- <br />Received <br />No[ Required <br />71ON AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF <br />NDONED FOR <br />B ZONING <br />A <br />CONSTRUCTION OR WORK IS SUSPENDED OR A <br />A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ENGINEERING <br />I HEREBY CERTIFY THAT I HAVE READ AHD EXAMINED THIS APPLICATION <br />AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF HEALTH DEPT. <br />UWS AND REGULATIONS GOVERNING TXIS TYPE OF WORK WILL BE <br />MPLIED WITX WHETXER SPECIFIED HEREIN OR HOT. THE GRANTING FIRE DEPT. ~ ~ ~ ' <br />CO <br />OF A PERMIT DOES NOT PRESUME TO GrvE AUTXORITY TO VIOLATE OR <br />UNC1 TXE PROVISIONS OF AHY OTX ER STATE OR LOCAL UW REGVUT• "' <br />' ~ ' <br />ING CONSTRURIOH OR THE PERFOR MAHCE OF CON STRURION. FEES: DRAINAGE AREA .~ <br />- '8°: PAYMENT <br /> BUILDING PERMIT ~ ^ ~ ~ <br />SIGNATURE OF CONTAAC TOR OR AUTHORIZED AGENT (DATE).-_ <br />. , i .I ~ _ - Check No. / LJ - Cash M.O. ~ -~ <br />~: <br />SIGNATURE OF Own ER (IF OWNER BUILDFRI (DATE) ~ r ` ; Total v r- <br />_ WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR Pr'_RMIT <br />PERMIT VALIDATION ~,,~`j - _ PERMIT NUMBER.. ~ <br />APPROVED BY ~. ~'i ~~ _ i ~ _. / i] i ~. i~ J. <br />