HomeMy WebLinkAboutApplication.pdfcE"> Garfield County
BUILDING PERMIT
Community Development Department
108 8 1h Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-county.com
APPLICATION I
L ____ . -------···-------___ _J
TYPE OF CONSTRUCTION -·' " -,,
D Commercial/Multi-Family ID Demolition
D Manufactured Home (SF or Duple x)
D Residential (SF, Duple x, or Townhome) I ~ Reroof
INVOLVED PARTIES
Property Owner: ~\A\ Iv 8-9-v<J
Mailing Address : 11 KS ft~ '(d
Contractor: ~~~~
Mailing Addre:,
'"' ' .~ ,. •.. .
Architect: _________________ Phone:( _______ _
Mailing Addres
Engineer: --'"'"-!fl--11==--------------Phone:( _______ _ 1'-'
Mailing Address: __________________________ _
Manufactured Home lnstalle ~-f-1<:::::>,._/ ---------Phone: ( _______ _
Mailing Address: __________________________ _
PROJECT NAME AND LOCATION
Describe Work:_~~~-~~~~~----------------------
JobAddress:~~L--~~li..Jl. ......... ~~uu.-""-U.4-1---------------~
Assessor's Parcel Number: Jrt~l'/8.:aJ-'O/Jsub. rrl(n.e~ ~&.J-j$:tot /3 Block
Owner's Valuation of Work: $ I o 1 CX:X)-P:opert,.y~e i sq.Ft or Acres):
Sq.Ft of Building : Height: di)~ -~10~___.d--=..._ __ _
Class of Work: D New 0 Alteration D Addition epair 0 Move/Relocation
Garage : D Attached 0 Detached
Septic: 0 ISDS 0 Community
Type of Heat: D Natural Ga s 0 Propane D Electric 0 Other
Driveway Permit: 0 Exe mpt 0 Permit#:
NOilCE
Authority. This application for a Building Permit must be sig ned by the Owner of the property, described above , or
an authorized agent. If the signature below is not that of the Owner, a se parate letter of authorit y, signed by th e
Owner, must be provided with th is Application.
Legal Access . A Building Permit canno t be issued without proof of leg al and adequate access to t he property for
purposes of in spection s by the Building Divi sion.
Other Permits. Multiple separate permits may be required : (1) State Electrical Permit, (2) County ISDS Permit, (3)
another permit required for u se on the property identified above, e.g. State or County Highway/ Road Access o r a
State Wastewater Discharge Permit.
Vold Permit . A Build ing Permit becomes null and void if the work authorized is not commenced withi n 180 days of
the date of issuance and if work is suspended or abandoned for a period of 180 days af ter commencement.
OERT~F.ICATION
I hereby certify that I have read this Application and that the information contained above is true and correct.
understand that the Building Di vision accepts t he Application, along with th e p lans and specifications and other
data submitted by me or on my behalf (submittals), ba sed upon my certification as to accuracy. Assuming
completeness of the submittals and approval of this Application, a Building Perm it w ill be issued granting
permission to me, as Owner, to construct th e structure(s) and facilities detailed on the su bmittals reviewed by t he
Building Division. In considera ti on of the issua nc e of the Building Permit, I agree that I and my agents w ill comply
with provisio ns of any federal, state or local law regulating the work and the Garfield County Building Code, ISDS
reg ulations and applicable land use regulations (County Regulation(s)). I acknowledge t hat the Bu il ding Permit
may be suspe nded or revoked, upon notice from the County, if the lo catio n, constr uction or use of the structu r e(s)
and facility(i es), described above, are not in compliance with County Regulation(s) or any other applicable law.
I hereby grant permi ss ion to th e Building Division to enter the property, described above, to inspect the work. I
further acknowledge that the iss uance of the Building Permit do es not prevent the Buildi ng Official from: (1)
r eq uiring the correction of errors in the submittals, if any, di scove red after issuance; or (2) stopping constr uction
or use of the structure(s) or facility(ies) if suc h is in violation of County Regul ation(s) or any other applicable law.
Review of this Application, including submittals, and inspections of the work by the Bu ilding Division do not
co nstitute an acceptance of respon sibility or liability by the County of errors, om iss ions or discrepanc ies. As the
Owner, I acknowledge t h at re spons ibilit y for compliance with federal, state and local laws and County Regu lat i ons
rest with me and my authorized agents, including without limitation my architect designer, engineer and/ or
builder.
,j0v\v.e, ~
-() I hereby acknowledge that I have rea and un
have provided the required information which is correct and accurate to the best of my knowledge.
\J/L ~AAJ d AA~ ---'-+-+/z~3/~14 __ ~ner ~ Date
· OFFICIA i! USE ONLY
Special Conditions:
Adjusted Valuation: Plan Check Fee : Permit Fee :
~ ~, ~ ..
Manu home Fee:
Total Fees : Fees Paid : Balance Due: BP No:
~ oO -(b~oo.~ 1 , Q2_
Setbacks : OCC Group:
BUILDING/ PLANNING DIVISION ' fvoJJ; Li 1 U. ,_ J1
Signed Approval
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Misc Fees:
ISDS No:
Date