HomeMy WebLinkAboutApplicationGARFIELD COUNTY BUILDING PERMIT APPLICATION
108 8th Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5003
www.earfield-county.com
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Parcel No: (this information is available at the assessors office 970-945-9134) tp IIDN— DI‘O�
2
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Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name & City) or and legal description
Jr c,Oun 2 c,,0 cs r I r 4 ]
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Lot No: Block No: Subd./ Exemption:
Cr,OO ti c
Misc Fees:
tirrter.3.- en wner
t� 1 _ f 4�-�-�-
Mailing Address:
? tiA
Mailing 'Address:
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u.`1CSzx) C.
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7#- i . ,
g ley. at/461
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Ph:
Ph:
G�9 •XL2g
Ph:
947-96Jti
Height:
-
Alt Ph;
Alt Ph: g
`l-1, �
Alt Ph:
5
Contractor:
)4C I) t Fry ,
6
Architect / Engineer.
'" /LIM 46 sal4A E011,)PC
Mailing Address:
NS 84flec Akic
Sq. Ft. or Acre of Lot:
-
7
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Sq. Ft. of Building:
6v
No. of Floors:
8
Use of Building:
APPROVAL DATE
9
Describe Work:
. rd,.,,T j arc
ti(C4143140.41,)
o Alteration ddition
10
Class of Work:
11
Garage:
ts-,Kttached o Detached
Septic:
o ISDS o Community
12
Driveway Permit: J
Owners valuation of Work: $ fid, bpm -
Authority.
This application for a Building Permit must be signed by
letter of authority, signed by the Owner, muse be provided
A Building Permit cannot be issued without proof of
NOTICE
the Owner of the properly, described above, or an authorized agent If the signature below is not that of the Owner, a separate
with this Application.
legal and adequate access to the property for purposes of inspections by the Building Department
Electrical Permit, (2) County ISDS Permit, (3) another permit required for use on the proprsty identified above, a g. State or
Discharge Permit.
is not commenced within 180 days of the date of issuance and if work is suspended or abandoned for a period of 180
CERTIFICATION
contained above is true and correct. I understand that the Building Department accepts the Application, along with the plans
based upon my certification as to accuracy
a Building Permit will be issued granting permission to me, as Owner, to construct the structure(s) and facilities derailed on
and my agents will comply with provisions of any fulcra!, state or local law regulating the work and the Garfield County Building
Regulation(s)). I acknowledge that the Building Permit may be suspended or revoked, upon notice from the County, if the location,
are not in compliance with County Regulation(s) or any other applicable law.
described above, to inspect the work. t funbcr acknowledge that the issuance of the Building Permit dors not prevent die
if any, discovered after issuance: or (2) stopping construction or use of the structure(s) or facility(ies) if such is in violation
work by the Building Department do not constitute an acceptance of responsibility or liability by the County of errors, omissions
compliance with federal, state and local laws and County Regulations rest with me and my authorized agents, including without
THE NOTICE & CERTIFICATION ABOVE
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t.eeal 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 authorized
I hereby certify
and specifications
Assuming
the submittals
In consideration
Code, 1SDS
construction
1 hereby grant
Building Official
of County
Review of
or discrepancies.
limitation
1 HEREB
days after commencement
that I have read this Application and that the information
and other data submitted by me or on my behalf (submittals),
completeness of the submittals and approval of this Application,
reviewed by the Building Department
of the issuance of the Building Permit 1 agree that 1
regulations and applicable land use regulations (County
or use of the strueture(s) and facility(ies), described above,
permission to the Building Department to enter the property,
from: (1) requiring the correction of errors in the submittals,
Regulation(s) or any other applicable law.
this Application, including submittals, and inspections of the
As the Owner. !acknowledge That responsibility for
my . r e - sig , engineer and/ or builder.
ACKNOWt ..D.s THAT I HAVE READ AND UNDERSTAND
OWNERS SIG ATURE DATE
STAFF USE ONLY
Special Conditions:
coves fib 7L
612'fix #21-.190
Adjusted Valuation: '
• COI
Plan Check Fee:
72.3f
Permit Fee:
M. 2.1-
Manu home Fee:
Misc Fees:
ISDS Fee:
Total Fees:
1e3.5Yv
Fees Paid:
i._3
Balance Due:
uI=L6
III' No & Issue Date:
ISDS No & Issued Date
--
1_.,‘
Setbacks:
OCC Group:
It IRO
1 Const Type:
(R&
Zoning:
(�
BLDG DEPT:r
*'\,\14 fl\'‘si3t\L\ Ite)
PLN ; DEPT:
sv
APPROVAL DATE
APPROVAL DATE
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