HomeMy WebLinkAboutApplicationGARFIELD COUNTY BUILDING PERMIT APPLICATION
108 8'h Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 1 Fax. 970-384-3470 / Inspection Line: 970-384-5003
www.Qarrield-countv.com
(this information is available at the assessors office 970.945-9134)
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2
Job Address: (if an address has_ot een asci ed, plc a provide Cr, Hwy or Street Name & City) or and legal description
Adjusted Valuation:
3
Lot No: Q Block St�bdr ggmptiowC
�jj ('C Cr
Manu home Fee:
r+� P
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Owner -(property own
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Mailing Address p
d CVtt� t AC
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7 7 0 -3 v I - Lr*
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Cpgractor:
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Mal •in Address:
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Ph:
570-, Ft"-D39F
Balance Due:
i a ,its
ISDS No & Issued Date:
t 3 . .7�
6
Architect / Enginc&:
Ma ng g Addrps: r , '
4 c J jam{
Ph:
Alt Ph:
7
Sq. Ft. of Building: , !�
Sq. Ft. or Acres of Lot:
Height:
No. of Floors:
i
8
Use of Building:
9
Describe Work: I a J 10 ul— eA_ C R�� k c 'f �P X
J I
10
Class of Work:
❑ New KAlteration ❑ Addition
11
Garage: 1, Septic:
❑ Attached ❑ Detached j o ISDS o Community
12
Driveway Permit: Owners valuation of Work: $
1
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, trust be provided with this Application.
Leeul Access. A Building Permit cannot be issued without proof of Legal and adequate necess to the property for purposes of inspections by the Building Department.
Other Permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County ISDS Permit. (3) another permit requited for use an the property identified above, a S. 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
1 hereby certify that I have read this Application and that the information contained above is true and correct. I understand that the Building Department accepts the Application, along with the plans
and specifications and other data submitted by me or nn my behalf (submittals), based upon my certification as to accuracy
Assurrung completeness of the submittals and approval of this Application, a Building Permit will be issued granting pemhiUioa to rue, a$ Owner, to construct the structure(s) and facilities detailed on
the submittals reviewed by the Building Department.
In consideration of the issuance of the Building Permii, 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 Regulatino(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, art: not in compliance with County Regulation(s) or any other applicable law.
1 hereby grant permus�ion to the Building Department to enter the property, described above, to inspect the work. 1 further UL knowledge 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 structum(s) or facility(ies) mf such is in violation
of County Regulation([) or any other applicable law
Review of this Application, including submittals, and inspections of the work by the Building Department do not constitute an acceptance of responsibility or liability by the County of errors, ornissions
or discrepancies As d Owner. 1 acknowledge that responsibility for compliantx with federal, state and local laws and County Regulations test with me and my authorized agents. including without
hmitation my archii igner• engineer and/ or builder
1 HEREBY ACh W TDGE THAT 1 HAVE ReAtt AN UNDERSTAND THE NOTICE & CERTIFICATION ABOVE
OAVNERS S GNATURE DATE
STAFF USE ONLY
Special Conditions:
Adjusted Valuation:
Plan Check Fee: Permit Fee:
Manu home Fee:
Misc Fees:
4�, 6 z a
2.3i 111--7- 5'
—~
--
ISDS Fee:
Total Fees:
Fees Paid:
Balance Due:
13P No & Issue Date:
ISDS No & Issued Date:
t 3 . .7�
721
lel 7- Jr
--rl
0
Setbacks:
OCC Group:
�-3
Const Type:
�g
Zoning:
Pia
rd'
BLDG DEPT:
PLNG DEPT:
100,
APPROVAL
!)ATIP,
I APPROVAL
DATE