HomeMy WebLinkAboutApplicationGARFIELD COUNTY BUILDING PERMIT APPLICATION
108 814 Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 888-868-5306
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SEP ! 5 2019
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1 1 Parcel No: (this infoq, on is available at the assessors office 970-945-9134)
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— Z.� b .- d/ BUILDING & PLANNNG
2 a Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name City) or and legal riptio
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3 ' Lust No. Block No: Subd./ Exemption:
4
O; a (pro owner)
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Mailing Ad�� ss:
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4S
ISDS Fee:
Total Fees:Fees
5
Contractor:"
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Mailing Address:
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97U -37J -79c-7
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6
Architect / Engineer:
Mailing Address:
Ph:
Alt Ph:
7
Sq. Ft. of Building:
Sq. Ft. or Acres OL t•
Height:)
�o. of Floors:
8
Use of Building:
9
Describe Work: Y 4
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I0
Class of Work:
a New n Alteration ❑ Addition !2 a 9/9 I
11
Garage:
Septic:
APPROVAL W DATE
❑ Attached a Detached
❑ ISDS o Cotnmuni
12 Driveway Permit: ✓f� „ — Owners valuation of Work: S Q�U
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NOTICE
utbori . This application for a Building Permit must be signed by the Owner of the property, described above, or an authonzed agent. If the signature below is not that of the Owner. a separate
letter of authority, signed by the Owner, must be provided with thus 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 Department.
Other Permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County ISDS Permit, (3) another permit required for use an the property idenufied above, e.g. State or
County highway/ Road Access or a State Wastewater Discharge Permit.
Void Permit. A Building Permit becomes null and void ifthe work authorised 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 eerily that 1 have read this Application and that the infomaum contained above is true and comet. I understand that the Building Department accepts the Application, along with the plans
and specifications and other data submitted by me or on my behalf (submittals), based upon toy unification as to accuracy
Assuming completeness of the submittals and approval of this Application, a Building Permit will be issued grauttag permission to mc, as 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 Permit, I •Site that I and my agents will comply with previsions 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 strucnae(s) and facility(ics), described above, are not in compliance with County Regulation(s) or any other applicable law.
I hereby grant permission to the Building Department to enter the property, described above, to inspect the work. I ftuther acknowIcdge that the issuance of the Building Permit does not prevent the
Building OfEcial 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 Reguladoo(s) 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 orliabiliry by the County of errors, omissions
or discrepancies. As the Owner, 1 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 & CERTIFICATION ABOVE
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OWNERS SIGNATURE DAT
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Cie uQ U j STAFF USE ONLY
1 0•W� f ahn nc��. M5N.c0l4A
Special Conditions:
Adjusted Valuation:
an Check Fee:
Permit Fee:
Manu home Fee: A4ise Fees:
3, 192- e.
ISDS Fee:
Total Fees:Fees
Paid:
$alance Due:
BE No & Issue Date:
ISDS Ng & Issued Date:
I60a46
IF o-58
Setbacks:
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OCC Group:
Coast Type:
Za ing:
Fzs
BLDG DEPT:
PLNG DEPT:
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APPROVAL DATE
APPROVAL W DATE