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BUILDING PERMIT APPLICATION Community Development Department [PHONE REDACTED] 1290 S. Public Road, Lafayette, Colorado 80026 Fax [PHONE REDACTED] Bldg Permit.doc Rev. 2/11/2009 Please Print or Type Project PROJECT ADDRESS (Number and Street) APPLICATION DATE LOT NUMBER BLOCK SUBDIVISION OR TRACT NAME Applicant CONTACT NAME EMAIL PHONE ( ) FAX ( ) COMPANY NAME MAILING ADDRESS (Street, City, Zip) Owner NAME OF PROPERTY OWNER EMAIL PHONE ( ) FAX ( ) COMPANY NAME MAILING ADDRESS (Street, City, Zip) Contractor COMPANY NAME MAILING ADDRESS (Street, City, Zip) CONTRACTOR TYPE LICENSE NUMBER PHONE ( ) FAX ( ) Other ARCHITECT MAILING ADDRESS (Street, City, Zip) PHONE ( ) ENGINEER MAILING ADDRESS (Street, City, Zip) PHONE ( ) Description PROJECT CATEGORY New Construction Plumbing Sign New Residential HVAC Fence Remodel Electrical Other Basement Roof Other DETAIL DESCRIPTION (Use reverse if necessary) PROJECT VALUATION $ ELECTRICAL VALUATION $ SQ. FT. New Resi COMMUNITY HOUSING PROGRAM UNIT INFORMATION ONLY Is this a Community Housing Unit? Yes No If yes, then complete the following: Proposed Sale Price Permanently Affordable Unit Market Rate Unit Charter Unit No. of Bedrooms: $ Applicant The information given on this application is accurate to the best of my knowledge. All provisions of laws and ordinances governing this work will be complied with, whether specified on this application or not. Granting a permit does not give authority to violate or cancel provisions of any other state or local law regulating construction or construction performance. The permit must be paid for within 45 days. The applicant agrees to pay the plan review fee whether permit is purchased or not. Applicant Signature Date COMMENTS/SPECIAL CONDITIONS Fee Type Amount Building Permit Fee $ BOCO Use Tax $ City Use Tax $ Electrical Inspection $ Water Tap $ Sewer Tap $ Drainage $ Service Expansion $ DATE RECEIVED STAFF APPROVAL INITIAL DATE Planning Public Works Fire Department Building LURA B. Star/CHP Parks and Tree Fee $ Public Arts Fee $ Engineering Inspection $ Electrical Temporary $ Plan Check $ Other $ TOTAL FEES $