HomeMy WebLinkAboutApplication.pdfcE> Gar/reid County Community Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.garfield-countv.com TYPE OF CONSTRUCTION 'B.: Commercial/Multi-Family
)!f~Demolition D Residential (SF, Duplex, or Townhome) [ I D Reroof 0 Manufactured Home (SF or Duplex) D Grading (locate all utilities prior to grading) INVOLVED PARTIES Property Owner:
¥: w....;;, '=> U __ <:-Phone: ( _ ) 121-"I (19 Mailing Address: I ~ 2--;>....-0.. "-A · ~ ~-----c ro, &-t1e"1.-1 Contractor: Phone: ( ) Mailing Address: Architect: Phone: ( _ ) Mailing
Address: Engineer: Phone: ( ) Mailing Address: Manufactured Home Instalier: Phone: ( ) Mailing Address: PROJECT NAME AND LOCATION Describe Work: '" ~ c") \: \,: '-L <:. V A...{L'\""
\.-';:V ):..J Job Address: S 'tO ...... c. TL. 1,'Vi Assessor's Parcel Number: Sub. lot --Block --Owner's Valuation of Work: $ j2f Property Size (Sq.Ft or Acres): 7 Sq.Ft of Building:
Height: # of Floors: Class of Work: D New I D Alteration I D Addition D Repair I D Move/Relocation Garage: D Attached D Detached Septic: D ISDS D Community Type of Heat: D Natural Gas
I D Propane ·1 D Electric 1 D Other Driveway Permit: D Exempt D Permit #: Grading Square Feet of Earthwork Cubic Yards of Earthwork
/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 true and correct. I understand that the Building Division accepts the Application,
along with the plans and specifications 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 t his Application, a Building Permit will be issued granting permission to me, as Owner, to construct the structurels) and facilities detailed on the submittals reviewed
by the Building 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 regu lati
ng 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 structu re(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 Building Division to enter the 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 submittals, 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 responsibility 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 provided the required information which is correct and accurate
to the best of my knowledge. Property Owner Print and Sign Date OFFICIAL USE ONLY Special Conditions: Awer V~~lion: Plan Check Fee: \--) I'PI Permit Fee: a ~~\S~ M~hr~~e: Mise Feer to
~ Total Fees: Fees Paid: ~r;~10 BP No: , ¢~. Q£ ~Q0;QQ-Drlro-;;JCJa Iff/JJ Setbacks: OCCGroup: Canst Type: ~Tgr BUILDING I PLANNING DIVISION: APt.l -4C. e!-(~ -J ?POp :3 ; , ;; Signed
Approval Date ~. \0 . ,{6 ~~llI."'-