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Call /Email — Date: - o Conf ❑ LVM o LM <br />LCityo Department of Planning and Building Safety <br />Louisville <br />COLORADO 1174 749 Main Street Louisville, CO 80027 303,335.4584 Fax 303.335.4588 www.louisvilleco.gov <br />RESIDENTIAL PERMIT <br />ln'S I F 'i D 1 <br />PERMIT <br />NUMBER: I rU0 <br />r yirte VI nRSD,ucimm- Inge ati y a Up ex <br />o Townhome o Apartment o Condo I <br />TYPE OF WORK: D New :Addition ❑Scrape off remodel itDemo <br />JOB ADDRESS (including Unit #): <br />lot ' 'Y0}'t aT " <br />WORK DESCRIPTION: include square footage <br />1st Floor: 3 i%' 2nd Floor : - 3rd Floor : <br />LEGAL DESCRIPTION (if known): <br />Lot: Block Subdivision <br />—' <br />_ <br />Garage: - Other: - <br />- <br />Basement: Finished: Unfinished: - <br />—' <br />Total Lot Area (SO. FT) 4919 <br />Sprinkled Area: ` <br />Construction Type: - Occupancy: _ - <br />BUILDING INFORMATION: <br />Owner Name: 'Joist M2,�- �1G. <br />Total Units: 1. # of Bedrooms: 1- # of Bathrooms: 4. <br />Permit to include: Electrical - ©Yes a No <br />Mechanical-to Yes a No Plumbing-0 Yes o No <br />Is this building 50 years or older? es a No <br />Address: in i3 r-+- <br />City. j l?11� Urlif, Zip: goaat <br />Phone: (n) el/6- - 9155' <br />- <br />JOB DES - IPTION• r " ^'.- <br />CQNTRACTQR iNFORMATIO� <br />Louisville License # <br />''. `4} "�:� a►= - , _� - -. <br />Business Name: N1c inn s 4t tfiil <br />1>f-4I,rrbv r 211/ r- paid Pas+a id 1a%, <br />Address: )l`11,1 i�9 Cl�` <br />ki-k/ .51-1/P J root{ 2I1 i letx- 744 pvio - e'7�5, <br />City: pryulc�.P.ti' Zip: <br />r <br />Phone: ( 17) 4) - is-4z <br />NOTE: For a multiple trade permit the Sub - contractor signature <br />form with original signatures is required prior to issuance of a <br />permit. <br />JOB SUPERVISOR: <br />Name: <br />t"►.i1 i <br />Jobsite Phone # ( ) - <br />Valuation <br />$ <br />_._ <br />- NOV 2, 8 lni <br />t5lSV1Li E <br />i 1. ©7AFE <br />ice--- <br />ARCHITECT / ENGINEER OF RECORD: <br />Name: f C miy/J , <br />Permit Fee <br />$ <br />Email: -h,ni4 we-if-644P is oval <br />Phone #: ( d�j) 415 - 9S4z. <br />This application becomes null and void if permit is not issued within 180 days of application date. I hereby certif that I have read and examined this application and <br />know the same to be true and correct. All provisions of law and ordinances governing this type of work will be complied with whether specified herein or not. The <br />granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or performance of construc- <br />tion. Permit and tap fees are subject to change at the beginning of each calendar year. <br />Note: A separate permit is required for signs, fences, irrigation systems & swimming pools unless noted on this application. Fees are assessed at time of permit issu- <br />ance and are subject to city ordinance in effect at that lime. <br />SIGNATURE LOCK: <br />Signature: <br />ff ��p _ <br />61j— Printed Name: 11vfd?my r` 'h1T+ Date: 1(•Z.la 0 <br />- <br />Address: 0 n <br />4Ht qtr. J Phone: (A)5 ) .41-;1 - J4 <br />Email Address: JGr © rC II t4e16, (001 Preferred Method of Contact: 0 Phone a Email <br />APPROVALS SIGNATURES DATE COMMENT, _ <br />Building l <br />_ <br />Zoning /HPC <br />Fire Department <br />Elevator Review <br />