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HomeMy WebLinkAboutApplicationGARFIELD COUNTY BUILDING PERMIT APPLICATION 108 8th Street, Suite 401, Glenwood Springs, Co 81601 Phone: 970-945-8212 / Fax: 970-384-34701 Inspection Line: 970-384-5003 www.narfield-countv.com STAFF USE ONLY Special Conditions: Parcel No: (this information is available at the assessors office 970-945-9134) / 7 9: ,5---,_,..? oo©tar° legal description 2 Job Address: (if an address has not been assigned, pleaseeaprovide Cr, Hwy or Street Name & City) or and O ciele . . z 3 Lot No: Block No: Subd.l Exemption: 4 Owner , rolrny owner) il, 4 450 Mailing Address: a :z. C,‹ , "Z7- , Ph: -a5 z-ST6 Alt Ph; ISDS No & Issued Date: Imp5 r• Mailing Address:......--. — Ph: Alt Ph: _/' 6 Architect / Engineer Mailing Address: Ph: Alt Ph: 7 Sq. Ft. of Building: Sq. Ft. or Acres of Lot: 3 Height: __y No. of Floors: �^ 8 Use of Building: ver cA. Describe Work: _ P 64446/Es 9 440011C- ©©110 10 Class of Work: �fNlew D Alteration o Addition 11 Garage:Septic: N o Attached o Detached o ISDS— o Community 12 Driveway Permit: ISL1 NOTICE the Owner of the property, described with this Application. legal and adequate access to the Electrical Permit, (2) County Discharge Permit. authorized is not commenced within CERTIFICATION contained above is true and based upon my certification a Building Permit will be and my agents will comply with Regulation(s)), 1 acknowledge are not in compliance with described above, to inspect if any, discovered after work by the Building Department compliance with federal, state THE NOTICE & CERTIFICATION S— Owners valuation of Work: $ fifFs-t1"1 J/ {—{L/�/�/C, above, or an authorized agent. lithe signature below is not that of the Owner, a separate property for purposes of inspections by the Building Department. ISDS Permit, (3) another permit required for use on the property identified above. e.g. State or 180 days of the date of issuance and if work is suspended or abandoned for a period of 180 correct. 1 understand that the Building Department accepts the Application, along with the plans as to accuracy issued granting permission to ire, as Owner, to construct the structure(s) and facilities detailed on provisions of any federal. state or local law regulating the work and the Garfield County Building that the Building Permit may be suspended or revoked. upon notice from the County, if the location, County Rcgulauon(s) or any other applicable law the work. 1 further acknowkdge that the issuance of the Building Permit does not prevent the issuance: or (2) stopping construction or use of the structure(s) or facility(ies) if such is in violation do not constitute an acceptance of responsibility or liability by the County of errors, omissions and local laws and County Regulations rest with me and my authorized agents, including without ABOVE: Z 8''7d Authorit . This application for a Building Permit must be signed by letter of authority, signed by the Owner, must be provided A Building Permit cannot be issued without proof of Legal Access. Other Permits. Multiple separate permits may be required (1) State County Highway/ Road Access or a State Wastewater Void Permit- A Building Permit becomes null and void if the work days after commencement 1 hereby certify that I have read this Application and that the information and specifications and other data submitted by me or on my behalf (submittals). Assuming completeness of the submittals and approval of this Application, the submittals reviewed by the Building Department In consideration of the issuance of the Buildinlr. Permit, I agree that 1 Code, ISDS regulations and applicable land use regulations (County construction or use of the structure(s) and facility(ies), described above. 1 hereby grant permission to the Building Department to enter the property. Building Official from: (I) requiring the correction of errors in the submittals, of County Regulation(s) or any other applicable law. Review of this Application, including submittals, and inspections of the or discrepancies. As the Owner, 1 acknowledge That responsibility for limitation my architect desir.oer, engineer and/ or builder. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ AND UNDERSTAND .i— — -- OWNERS SIGNATURE DATE STAFF USE ONLY Special Conditions: Adjusted Valuation: � Plan Check Fee: Permit Fee: Manu home Fee: Misc Fees: ISDS Fee: �-- Total Fees: 10° Fees (t),00 Paid: Balance Due: uc BP No & Issue Date: 156 6 ISDS No & Issued Date: Setbacks: OCC Group: — Const Type: Zoning: BLDG DEPT � — �Z � lb L c(9 PLNG DEPT: APPROVAL DATE APPRO DATE