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Call/Email - Date ❑ Conf o LVM ❑ LM <br />City Department of Planning and Building Safety <br />Louisville <br />749 Main Street Louisville, CO 80027 303.335.4592 Fax 303.335.4588 www.lottisvilleco.gov <br />COLORADO•SlNCE I87 <br />HISTORIC DEMO PERMIT <br />PERMIT <br />NUMBER: <br />JOB ADDRESS (including Suite /Unit #): <br />a/G ,ryia „g., •5-4, <br />TYPE OF WORK <br />❑ Full Demo of Historic Structure <br />13/Partial Demo Of Historic Structure <br />LEGAL DESCRIPTION (if known): <br />Lot: Block Subdivision <br />JOB DESCRIPTION: <br />Total Lot Area (SQ. FT) <br />Mac ,P S;ci,ti1 Ze #Snort- Y.-a <br />Year Built <br />o Residential o Commercial <br />`p°S 44, l'e Xer(et c r p44, ,evt C-, fr.. izcra.i <br />BUILDING INFORMATION: <br />Owner Name: Vs‘ /K9id «t Le- C___ <br />Address: el /6 /flek, v .57/ <br />City: Le,c -{,su, /% Zip: SecLg7 <br />Phone: Fos )a7 - 674' <br />CONTRACTOR INFORMATION: <br />Louisville License # <br />Business Name: <br />Address: <br />City: _ Zip: <br />L <br />Phone: ( ) - <br />Valuation <br />, ” ' <br />AUG 0 4 2014 <br />JOB SUPERVISOR: <br />Name: <br />Permit Fee <br />$ <br />Jobsite Phone # ( ) - <br />CITY OFALOUISVVILL LOUISVILLE <br />Ttisappildiantreeorres null and void if permit isTrotIssuedvAd n180daysdappllatiandate.Ihereby certify tile% liar e�aninedthisappiationand <br />ImoNthe sane tobethe and correct All provisions of ION ald oalinancesgmening Mks type d week will be carolled WM %tether spedfiad herein or not The <br />grantingdapemitdoesnotpresrretogiveautiroritytoNdateorcancelt heprov isiansof arystateor locallawnegtiatingco structionorperfonsancedoorstruo- <br />Von Pen* and tap fees aesutiectto change at the beaiming death calendar year. <br />Nola a separate omit is required for signs, farces, Irrigation systems &mirming pools mess noted cadge appiica lon Fees are assessed attinact pen* Tssu- <br />ance and aresuti ecttodtyardnono )Ineffectatthatdrra <br />SIGNATUR OCK• •�~ <br />Signature: ru e Printed Name: �3c-cw•e s 4--/cx • Date: V / <br />Addres . chi /e: � -kz/,v 5 /- Phone: (=V P'4r4r • to 7 Gy <br />Email Address: : 01 (e e.• r...�a..5 rw c., gm, •-, {• <0,1V1 Preferred <br />Method of Contact: ❑ Phone ❑ Email <br />APPROVALS SIGNATURES DATE COMMENTS <br />Building /Electrical <br />Zoning /HPC <br />