HomeMy WebLinkAboutApplicationGARFIELD COUNTY BUILDING PERMIT APPLICATION
108 8th Street, Suite 401. Glenwood Springs, Co 81601
Phone: 970-945-8212. Fax 970-384-3470 r Inspection Line. 888-868-5306
www.rfield-courity.corn
AUG 2, 9 2012
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Parcel N (phi fo:ll [iqn� is available at the assessors office 970-945-9134) c_
o? O Coob, 00D/
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Job Address: (Wan address has not been assigned, please provide Cr, Hwy or Street Name & City) or and legal description
a I S4 Ca ywf ei AO 130 , GL 6:11 WORD 53,»5 a &' /
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Lot No. Block Na. Subd.I Exemption:
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Over: (propertyo
AD liOrt`
M ing Address: •
Pd d x 3, GzA,415
Ph:
97o-9gs--7/41%
Alt Ph;
9 '0-329-970
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Contractor:
Se -Lc
Mailing Address! f
Ph:
Alt Ph:
6
Architect/ Engineer
Mailing Address:
Ph:
Alt Ph:
7
Sq. Ft. of Building:
2.8 d
Sq. Ft. or Acres of Lot: -�
Height:
No, of Floors:
Use of Building: j
e$f 0e7JCa-
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Describe Work: Zoog /95,0 4LT' S} !ll%eG&'S
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Class of Work!
o New o Alteration o Addition
Ti
Garage,
XAttached o Detached
Septic:
o ISDS o Community
12
Driveway Permit:
Owners valuation of Work: $ gf 006 dr
above, or an authorized agent. lithe signature below is not that oldie Owner, a separate
properly for purposes of impactions by the Building Depanment.
[yds Permit, (3) another permit required tor use on the property identified above, e.g. State or
180 days a fthe date of issuance and if work is suspended or abandoned for a period of 180
correct 1 underhand that the Building Department accepts the Application, along with the plana
as to accuracy.
issued granting permission to me, as Owner, to construct the strucrute(s) and facilities detailed on
prvvlsions of any federal, state or local law regulating the work and the Garfield County Building
that the Building Permit may be suspended or rooked, upon notice from the County, if the location,
County Regulation(s) or any other applicable Iaw.
the work. 1 further acknowledge that the issuance of the Building Permit does not prevent the
issuance; or (2) stopping construction or use of the structure(s) or fatility(ies) if such is in tnoletion
do not constitute an acceptance of responsibility or liability by the County of [mors. omissions
and local laws and County Regulations rest with mead my authorised agents, including without
ABOVE.
0.1y2 q 1 2. ----
A uthn rift,
This spoliation fora Building Permit must be signed by
letter of awhceity, signed by the Owner, must be provided
A Building Permit cannot be issued without proof of legal
NOTICE
the Owner of the property, described
with this Application.
and adequate access to the
Electrical Permit, i2) 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
AND THE NOTICE & CERTIFICATION
Les.' Accent.
Other Penni& Multiple separate permits may be requited: (1) State
County Highway/ Road Access or a State Wastewater
veld Permit. A Building Permit becomes null and void if the work
days alter commencement.
I 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 tho submittals and approval of this Application.
the Submittals reviewed by the Building Department.
In consideration of the issuance of the Building Permit, 1 agree that I
Code, ISDS regulations and applicable land use regulations (County
canuntetion or use of the structure(s) and feciltty(ies), described above,
1 hereby grant permission to the Building Department to enter the property;
Building Official from: (Unwiring the correction of errors in the submittals,
of County Regulation(s) or any other applicable Iaw.
Review of this Application, including submittals, and inspections of the
or discrepancies. As the Owner, I acknowledge that responsibility for
limitation my architect designer, 'neer and/ or builder.
1 HEREBY ACKNOWLEDG T t VE READ A31Di r
OWNERS SIGNATURE DATE
STAFF USE ONLY
Special Conditions:
Adjusted Valuation:
.--te:"—
Flan Check ENI4L,
A / D p /
Permit Fee:
Manu home Fee:
--C=.-
-CISDS
Misc Fees:
ISDSFee:
T al Fees:
/�° -
s Paid: !�
/042),
Balance Due:
-1t,--oGW
BP No & Issue--77Date:
ISDS No & Issued Date:
R
Setbacks:
OCC Group:
Const Type: ] tatting;
BLD D :lir
4111. A
Z 87.19 /a
PLVG DEPT:
APPROVAL DATE
APPROVAL DATE
ZO/ZO 3910d
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