HomeMy WebLinkAboutApplication.pdfGarfield County RE C r p . t d'tTlmunity Development Department OCT 1 1 2013 GARFIELG L:lh . )MMUNITY DFVELO;\ ~ 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www.garfield-count
v.com TYPE OF CONSTRUCTION 0 Manufactured Home (SF or Duplex) 0 Commercial/Multi-Family 0 Demolition INVOLVED PARTIES 1121 Residential (SF, Duplex, or Townhome) I III Reroof Property
Owner: /tfl/1 q L . £I!£~a. d:. :c: <: ~ Phone: ( '/'10 ) ?"J9 -S' 19d Mailing Address: ta t. /"'"'6, QL'l 11 ~cc:~ TI I C ,:c. Contractor: ~~ \ ~ t: 'fCl!~ e r~ '\2,,, ..60l'qh.aJN>hOne:
!?? aj ) f<j 5 " 7 /0S Mailing Address: 5" Q<:P :£ ~ 115 i-IlN t .. y (, c-..,a~( (1o>t-:6 &.-Ifui lid Sp Architect: Phone: ( ) Mailing Address: Engineer: Phone: ( ) Mailing Address:
Manufactured Home Installer: Phone: ( ) Mailing Address: PROJECT NAME AND LOCATION Describe Work: £ <'C2Q ~ ,, f7'to !I,c e. /r Qi£' 4a-7 Job Address: /,/2/C',J.t 9 At} · L (7/' Assessor's
Parcel Number:;J./(c:i3'1~a"VJ "?"" Sub. WcQb{ MiG lot Block I Owner's Valuation of Work: $ Property Size (Sq.Ft or Acres): Sq.Ft of Building: Height: # of Floors: Class of Work: o New
I 0 Alteration I 0 Addition Ii9 Repair J 0 Move/Relocation Garage: o Attached o Detached Septic: o ISDS o Community Type of Heat: o Natural Gas I 0 Propane I 0 Electric I 0 Other Driveway
Permit: o Exempt o Permit#: I
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 ISDS 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.
I hereby 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 this Application, a Building Permit will be issued granting permission to me, as Owner, to construct the structure(s) 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 regulating the work and
the Garfield County Building Code, ISDS 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 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 responsi bility 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 th/~yuired in7 . :;..<~-which is correct and accurate to the best of my knowledge.
)0-//-r5 PropertY' Owner Print ang,si n Date OFFICIAL USE ONLY Special Conditions: Adjusted Valuation: Balance Due: ~QJ2-Setbacks: DCC Group: BUILDING /PLANNING DIVISION : -='L~;;::~~c:;:::::;;t:,===
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