HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945 -8212
www.garfield-countv.com
TYPE OF CONSTRUCTION D Commercial/M ulti-Family D Manufactured Home (SF or Dupl ex) D Residential (SF, Duplex, or Town home)
INVOLVED PARTIES
ID Demolition
/
1121' Reroof
Property Owner: ::P.-<±t f /1,J' :C /£wA>=+ Phone: ( 'llv ) 'l'Yf--g 9 YO
Mailing Address: I r 1--{._a.~-c. u t.6.a.
/ 4.1.~ .f¥.«1."J~1 C2
Contractor: ,Ji;k,v-_.-.-r:,, _ _f_ _/_ . ._ .J-,/..t:: -Phone: ( .'LP ) Y tJ..--Z.6.5 2
( ;&1r:. / Cv Mailing Address : S 1_o/ cdl/..~ ~//, ~ ...::> r
Architect: ;.;112 Phone:( __ )
Mailing Addre ss:
Engineer: A) I& I
Phone: ( )
Mailing Address :
Manufactured Home Installer: ,J-114-Phone: ( )
I
Mailing Address :
PROJECT NAME AND LOCATION
Descr i be Work: /£.'~a.~ .:fj~J-/ t'7t 2-' ~-~~~L. ~L.~s-?
Job Address : /~.;?-('~ L R.' .,_.._// I 6 v ~"..?. -// «:----
/ r , -
Assessor's Parcel Number: ~18621:I0'7aYo Sub . Lot Block --
Owner's Valuation of Work: $ Property Size (Sq .F t or Acres):
Sq .Ft of Bu ilding: Height: #of Floors:
Class of Work: D New I D Alteration ID Addition D Repair I D Move/Relocat ion
Garage: D Attached D Detached
Septic: OOWTS D Community
Type of Heat: D Natural Gas I D Propane I D Ele ctric I D Other
Driveway Permit: D Exempt D Permit#:
NOTICE
Authority. This application for a Building Permit must be signed by the Owner of the property, desc rib ed 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 iss ued without proof of lega l and adequate access to the property for
purposes of inspections by the Building Divi sion .
Other Permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
(3) another permit required for u se on th e property identified above, e.g. State or County Highway/ Road Access or
a State Wa stewater Discharge Permit.
Void Permit. A Building Permit becom es null and void if the work authorized is not commenced within 180 day s of
the date of issua nce and if work is sus pend ed 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 pl an s and specifications and other
data submitted by me or on my behalf (submittals), based upon my certification as to accuracy. Assuming
completeness of the submitta ls and approval of this Application, a Bu ilding Permit will be iss ued granting
permi ssion to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by th e
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, OWTS
regulations and applicable land u se regul ations (County Regulation(s)). I acknowledge that the Building Permit
may be suspended or revoked, upon notice from the County, if the location, construction or u se 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 sub mittals, if any, discove red after issuance; or (2) stopping construction
or use of th e structure(s) or facility(ie s) if such is in violation of County Regulation(s) or any other app li cable law.
Review of this Application, including submittals, and inspections of the work by the Building Division do not
constitute an accep tance of respon sibility or liability by the County of errors, omiss ion s or di screpan cies. As the
Owner, I acknowledge that re spon sibi lity for compliance with f edera l, state and loca l laws and County Reg ul ation s
rest with me and my authorized agents, including without limitation my architect designer, engi nee r an d/ or
builder.
I hereby ;~edge that I have read and understand the Notice and Certification above as well as
have pr:o..vi ~the required information which is correct and accurate to the best of my knowledge.
OFFICIAL USE ONLY
Special Conditions:
Adjusted Valuation: Plan Check Fee: Permit Fee: Manu home Fee:
~QC).~
Balance Due:
~ • <!I:>
Setbacks: OCC Group:
BUILDING/ PLANNING DIVISION : l{6no-JA U~
Signed Approval
I
Date
Misc Fees:
Date