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COMMUNITY DEVELOPMENT DEPARTMENT 1290 S. Public Rd. Lafayette, Colorado 80026 (303) 665-5588 Fax (303) 665-2153 FLOODPLAIN DEVELOPMENT PERMIT ($50 application fee) In accordance with the Lafayette Floodplain Standards, a Floodplain Development Permit shall be obtained from the Community Development Department before construction or development begins within any area of special flood hazard as recognized in the adopted Flood Insurance Study as identified in §26-23-4 of the Code of Ordinances. Please complete the following and attach any appropriate information. Also, please attach any appropriate plans drawn to scale showing the nature, location, dimensions and elevations of the area in question; existing or proposed structures; fill; storage of materials; drainage facilities; and the location of the foregoing. 1. Project 2. Applicant 3. Applicant 4. Applicant 5. Project 6. Township-Range-Section:_____1/4_____1/4_____1/4 Section____Township___Range___. 7. Boulder County Assessor Parcel 8. The proposed development/fill is located in the ____Floodplain; ____Floodway; or____Floodway Fringe. 9. The Base Flood Elevation at the project site is ____NAVD ____NGVD. 10. The source documents for the Base Flood Elevation 11. The elevation in relation to mean sea level, of the lowest floor (including basement) of all An Elevation Certificate by a registered professional engineer will be required. 12. The elevation in relation to mean sea level to which any structure has been flood- A certification by a registered professional engineer or architect that the flood-proofing methods for any nonresidential structure meet the flood-proofing criteria of §26-23-17(b) of the Lafayette Code of Ordinances ---PAGE BREAK--- 13. The elevation in relation to the mean sea level to which compacted fill is to be A certification by a registered professional engineer will be required. 14. Brief description of project (include the extent to which any watercourse or natural drainage will be altered or relocated as a result of the proposed development): 15. Purpose of project: In accepting this permit, the applicant understands that all conditions of the permit must be met, all other regulatory permits have been obtained, an elevation certificate will be provided once project is completed, and agrees to allow on-site inspections, as needed during or after construction, to determine compliance with this permit. Applicant Signature: Date: Action Taken (City of Lafayette Use Only) Permit Approved Permit Approved subject to conditions Permit Denied Conditions of Approval: Approved: Lafayette Floodplain Administrator Date