HomeMy WebLinkAboutApplication.pdfRE C~.-"--'-Garfield County \"V ~B\nfnunitv Development Department 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.garfield-county.com TYPE OF CONSTRUCTION 0 Commercial/Multi-Fami
ly 0 Manufactured Home (SF or Duplex) 1ia' Residential (SF, Duplex, or Townhome) INVOLVED PARTIES Property Owner: ~~ Mailing Address: 3i/f!f~ SIre~ 10 Demolition l lil Reroof Phone:
( ~/7 ) ;;''3<1,1953 &~t. 1Ik ~J.{lb Contractor: &el t:v ~lt.d MJJ t -:!~ . Phone: ( 970 ) '1//,., bSh3 j Mailing Address: /.fJ. B6t. 1CJ I tJ1'1'f {wl""/-VJ fillet-, Co.VI",.k/~, e".
V/'"J-1> A> flj Architect: Phone: ( ) Mailing Address: Engineer: NLA Phone: ( ) Mailing Address: Manufactured Home Installer: NL-4 j Phone: ( ) Mailing Address: PROJECT NAME AND LOCATION
Describe Work: -ftAlt.£( e¥r.sf ....... '1 /)J(J()/s~#vke.. ~n., I/JI. /'h(A.) ... ~e. ot-ba""" 1O!tl.( IJ ~t./.;"" j,4Jj.j.I. I,: ... "~ ;f./?, oi"",;V«;{tV s~,dl. Ve~!I~t)J.. 1=: ....
ba.~it.t' sLc.e..f,tkw ~ \J Job Address: U It:, iJ-. tl\ Ib'J. Assessor's Parcel Number:;'18,~ 3'ft.t7~·O(;l3 sub.0e:)f'f.~ ~ pJe~WI£CI~~~ '5 Block --Owner's Valuation of Work: s /f;J.t!J'1,
N~ . ~ Property Size (Sq.Ft or Acres): 4.I,.a Sq.Ft of Building: 91 ~7i • Height: ~()I /I of Floors: ;< Class of Work: o New 116' Alteration 1 0 Addition o Repair 1 0 Move/Relocation
Garage: :81Attached o Det ached Septic: o ISDS ? o Community Type of Heat: o Natural Gas .? 1 0 Propane ~. 1 0 Electric !' 1 0 Other Driveway Permit: o Exempt o Permit #:
NOTICE Authority. This application for a Building Permit must be signed by the Owner of the property, described above, or an authorized agent. If the signature below is not that of the
Owner, a separate letter of authority, signed by the Owner, must be provided with this Application . legal Access. A Building Permit cannot be issued without proof of legal and adequate
access to the property for purposes of inspections by the Building Division. Other Permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County 1505 Permit,
(3) another permit required for use on the property identified above, e.g. State or County Highway/Road Access or a State Wastewater Discharge Permit. Void permit. A Building Permit
becomes null and void if the work authorized is not commenced within 180 days of the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
CERTIFICATION I hereby certify that I have read this Application and that the information contained above is tru e and correct. I understand that the Building Division accepts the Application,
along with the plans and specifica tions and other data submitted by me or on my behalf (submittals), based upon my certification as to accuracy. Assuming completeness of the submittals
and approval of this Application, a 8uilding Permit will be issued granting permission to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed
by the Bui lding Division. In consideration of·the issuance of the Building Permit, I agree that I and my agents will comply with provisions of any federal, state or local law regulating
the work and the Garfield County Building Code, 1505 regulations and applicable land use regulations (County Regulation(s)) . I acknowledge that the Building Permit may be suspended
or revoked, upon notice from the County, if the location, construction or use of the structure(s) and facility(ies), described above, are not in compliance with County Regulation(s)
or any other applicable law. I hereby grant permission to the Bui iding Division to enter t he property, described above, to inspect the work. I further acknowledge that the issuance
of the Building Permit does not prevent the Building Official from : (1) requiring the correction of errors in the su bmittals, if any, discovered after issuance; or (2) stopping construction
or use of the structure(s) or facility(ies) if such is in violation of County Regulation(s) or any other applicable law. Review of this Application, including submittals, and inspections
of the work by the Building Division do not constitute an acceptance of responsi bility or liability by the County of errors, omissions or discrepancies. As the Owner, I acknowledge
that responsibility for compliance with federal, state and local laws and County Regulations rest with me and my authorized agents, including without limitation my architect designer,
engineer and/or builder. I hereby acknowledge that I have read and understand the Notice and Certification above as well as have prov= r~ed information w: and accurate to th;S~ o~m~
~n:w;:: . Property Owner Print and Sign 0 VINet Ilc7"'. Date OFFICIAL USE ONLY Special Conditions: Adjusted Valuation: Plan Check Fee: Permit Fee: Manu home Fee: Mise Fees: Boq \'-l3.
-/" &>IOJ,:'-----Total Fees: Fees, Paid ~ Balance Due: BPNo: ISDS No: ~IOCJ ·-I ~\OO·-6 I ~(;()f -d-q (p S ./" Setbacks: OCC Group: Const Type: Zoning: \\~ R--' o ALj Q' -20---2,0 S
BUILDING /PLANNING DIVISION: ~ Si~proval '-Date