HomeMy WebLinkAboutApplicationGay -j ie Zd GrC)
108 8r'' Street, Suite 401, Glenwood Springs, CO 81601
Ph: 970-945-8212 F:r:970-384-3440 Inspection Line:888-868-5306
vAstv.gart1eld-coontv.cont
BUILDING PERMIT APPLICATION
v 1vael l a L). C Oµ
I r
Parcel No: (this infOrtnationis available at the assessors office 9711-945-9134)
2/-7:1-• Zl1— 00 -. G roc/
Lot No: Block No: Subd./ Exemption:
SCcr 1.1 7•rNsill v Co it."M6 t- of Z 17.r c,,L 3 1
2
Job Address: (elan address has not been assigned, please provide CR, 111 PY or Street Name cc City) or and legal description l j
5-95 C.s44,it_ ISA -K— R -a 5, IT, t`D S7 $t.
3
Owner: (property owner)
1-4-1,36.— es t44, - r,- 4M
Mailing Address:
515- CiM r4.,` /t-4 s,/T[ o
Ph:
170 - 309 -1 4 7q
Alt Ph:
4
Contractor:
Mailing Address:
Ph:
Alt Ph:
5
Manufactured home installer:
Mailing Address:
Ph:
Lic #:
6
Architect:
Mailing Address:
Ph:
Alt Ph:
7
Engineer:
Mailing Address:
Ph:
Alt Ph:
8
Sq. Ft. of Building:
X•1810
Sq. Ft. or Acres of Lot:v 3
Height:
/zr
No. of Floors:
r
9
Use of Building:
BResidcntial ❑Commercial Daher
Class of Work:
faNew ❑Alteration ❑Addition ❑Repair ❑Demo ❑Move
10
Describe Work:
PI G 741 G 44.4(.6" ear' -;44641 5idtd)
i
Garage:
❑Attached Detached
t�Wooe/�r
Septic:
DISDS ❑Community
Type of Heat:
❑Nat. Gas ❑Propane ❑Electric tIQther
12
Driveway Permit: LXI STl 1`► C'i
C
Owners valuation of Work:
NOTICE
Authnrity. This application for a Building Permit must be signed by the Owner of the property, described above, or an authorized agent. Vale signature below is not that ()film Owner, a separate
letter of authority, signed by the Owner, must be provided with this Application.
Leval Acetyl, 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 rermith. Multiple separate paints may be required: (1) Stale Electrical Perinit, (2) County ISDS Permit, (3) another permit required for use on the property identified above, e.g. Stott or
County Ilighway/ Road Access or a Slate Wastewater Discharge Permit.
Void permit, A Building Permit becomes null and void if the work authorized is not commenced within 180 days oldie date of issuance and if work is suspended or abandoned fora period of 180
days after commencement.
CERTIFICATION
I hereby certify that I have read this Application and that the information contained above is true and correct. 1 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 my certification as to accurary.
Assuming completeness of the submittals and approval ofthis Application, a Building Permit will be issued granting permission to me, as Owner, to construct the struetutc(s) and facilities detailed on
the submittals reviewed by the Building Department.
In consideration ofthe issuance of the Building Permit, I agree that 1 and my agents will comply with provisions of any federal, state or local law regulating the work and the Garfield Comity Building
Code, ISDS regulations and applicable land use regulations (Courtly Regulation(s)), I acknowledge dial din Building Permit may be suspended or revoked, upon notice from the County, if the location,
construction or use °fate struclure(s) and faciliry(ics), described above, are not in compliance with County Regulation(s) or any other applicable law.
1 hereby grant permission to the Building Department to enter the property, described above, to inspect the work. 1 further acknowledge that the issuance of the Building Pcrnil docs 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 structure(s) or facility(ies) if such is in violation
of County Regulation(s) or any otter applicable law.
Review of this Application, including submittals, and inspections ofthe work by the Building Department do not c°nstitule an acceptance of responsibility or liability by the County °ferrous, omissions
or discrepancies. As die Owner, I acknowledge that responsibility for compliance with federal, state and local laws and County Regulations test with me and my authorized agents, including without
limitation my architect designer, engineer and/ or builder.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE NOTICE 3 CERTIFICATION ABOVE.
VNERS SIGNATURE DATE
f 1 '
o
('K�f0�3/
STAFF USE ONLY
Special Conditions:
Adjusted Valuation:
z<5,RZof
Plan Check Fee:
z6o.e8
Permit Fee:
LIol. 35
Manu home Fee:
Alise Fccs:
Total Fees:
662-z3
Fees Paid:
3� `5
Balance Due:
283.18
RP No & Issue Date:
ISDS No & Issued Date:
-7��1
Setbacks: / OCC Group ••12-Canst
F2.5,1 ZS, �2 Z,5 51 O i
Type: g�
Zoning:
IIL4F,DEP • e.e...... s 05://
APPR VAL DATE
ArrRDATE