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This application is to be used when requesting a Floodplain Development Permit from the Floodplain Administrator concerning proposed construction in the Flood Regulatory District in accordance with the applicable sections in the City of Arvada Land Development Code. SECTION I: APPLICANT INFORMATION Project Information Project Name: Project Street Address: Project Description: Applicant Contact Information Agent for Property Owner Property Owner Name: Company: Email: Phone: Address: City, State, Zip: Project Categories & Costs (Check all that Apply) Single Family Residential New Construction Fill Multi-Family Residential Expansion/Addition Utilities Manufactured (Mobile) Home Rehabilitation/Remodel Roadway/Trail Non-Residential Routine Maint./Small Project Bridge/Culvert Accessory Structure Grading Channel Project Other: Project Improvement Costs: $ Please attach applicable drawings and plans that depict the proposed construction. By submitting this permit application, I certify that I am the property owner (or authorized representative) and that the information contained within this application is true and accurate. I also agree to comply with all the laws and requirements of this Floodplain Development Permit. Signature: Date: Printed Name: APPLICANT STOPS AT THIS POINT SECTION II: CITY USE ONLY ENGINEERING DIVISION FLOODPLAIN PERMIT NO. Permit Fees: Fence/Shed/Misc. $50 Building Footprint Expansion $200 Garage/Deck/Impr. <50% Bldg. Value $100 Any Improvement >50% Bldg. Value $200 Fill or Grading Only $200 New Building Construction $500 New Floodplain/CLOMR/LOMR $500 Remodels, Damaged Structures and Redevelopment Only 5-Year Cumulative Value of Improvements: $ Value of Structure: $ Is Cost a Substantial Improvement 50% of Structure Value)? Yes No Applicable Construction Certificates Elevation Certificate Residential Basement Floodproofing Non-Residential Floodproofing Engineered Opening Certification Revised January 1, 2023 8101 Ralston Road, Arvada, CO. 80002 [PHONE REDACTED] (Engineering) FLOODPLAIN DEVELOPMENT PERMIT ---PAGE BREAK--- SECTION II CONT.: CITY USE ONLY Review Checklist All Projects Site Plan Engineering Plans CLOMR Required SFHA Previous Improvement LOMR Required Floodway Non-Conforming Use LOMR-F Required SFHA Projects Walled & Roofed (Insurable Structure) Anchoring Enclosure > 120 Square Feet Flood Resistant Material Utilities Historic Structure Previous LOMR-F Floodway Projects Agricultural Use Utilities Bridge/Culvert No-Rise Certificate Required Roadway/Trail Recreational Use Other: Permit Conditions Fill in Approved Areas No Fill No Prohibited Materials No Basement Anchoring Required Feet, Lowest Floor Above Ground Utilities Protection Required Feet, Floodproofing Above Ground Enclosure Openings Required Feet, Flood Resistant Materials Above Ground Other: Revised January 1, 2023 Project Flooding Information Flooding Source (River, Stream, Waterway): FEMA Zones Impacted: A AE AH AO X Structure in Floodway? Yes No Property in Floodway? Yes No Impacted by a LOMR? Yes No Case No.: FEMA Base Flood Elevation (BFE): (Feet NAVD’88) Applicable FIRM No.: Effective Date: FIS Effective Date: Permit Action Permit Approved: The information submitted for the proposed project was reviewed and follows the City’s floodplain management requirements (see applicable permit conditions above). Permit Denied: The proposed project currently does not meet the City’s floodplain management requirements. Reason Denied: Floodplain Administrator Signature: Date: Compliance Documentation Construction Certificates: Certified documentation by a registered professional engineer/surveyor/architect of as-built conditions for finished fill, lowest floor elevation, floodproofing measures, and/or other flood protection factors are following the approved plans. Received On: Initials: LOMR or LOMR-F Completed? Yes No Case No.: Effective Date: Project Compliance: Confirmed On: Initials: