HomeMy WebLinkAboutApplication.E
LU
Garfield County
APR 2 lq.Wimunity Development Department
108 Bei Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.,qarfield-county.com
TYPE OF CONSTRUCTION
❑ Commercial/Multi-Family
❑ Manufactured_ Home (Single or Multi -Leve
0: Residential (SF, Duplex or Townhome)
❑ Demolition
❑ Reroof
INVOLVED PARTIES c�
Property Owner: &n� Phone:(/03Q)
Mailing Address: f �� I!D[ v�2r%olJT • �� ('Lr.��i� , ��• ��j
Contractor:
Mailing Address:
Architect:
Mailing Address:
Engineer: Phone:
Mailing: Address:
Manufactured Home installer:
Mailing Address:
PROJECT NAME AND LOCATION
Describe Work: —?-&p
Job Address: PA-up-�IO c,—� '`_ ,. _ (R-&
21z33H3,3oo✓ .._
Assessor's Parcel Number: Sub.Ll ,_ Lot Block
Owner's Valuation of Work: $_ fLa Property Size (Sq. Ft. or Acres):
Sq. Ft. of Building: (7_x1 f��gC. Height: # of Floors:
Class of Work: mew ❑ Alteration ❑ Addition ❑ Repair ❑ Move/Relocation
Garage: ❑ Attached ❑ Detached
Septic: I ❑ OWTS 1 ❑ Community
Type of Heat: ❑ Natural Gas ❑ Propane ❑ Electric ❑ Other
Driveway Permit: ❑ Exempt 13 Permit #:
NOTICE
Author! . !his application for a Building Permit must be signed by the Owner of the property, described above, or
an authorized agent. If the signature below is not that of the Owner, a separate letter of authority, signed by the
Owner, must be provided with this Application.
Leda! Access. A Building Permit cannot be issued without proof of legal and adequate access to the property for
purposes of inspections by the Building Division.
Other Permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
(3) another permit required for use on the property identified above, e.g. State or County Highway/ Road Access or
a State Wastewater Discharge Permit.
Void Permit. A Building Permit becomes null and void if the work authorized 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 - —
I hereby certify that I have read this plication and that the information contained above is true and correct. I
understand that the Building pivision cepts the Application, along with the playas and specifications and other
data submitted by me or on my behalf kubmittals), based upon my certification as to accuracy. Assuming
completeness of the submittals and app oval of this Application, a Building Permit will be issued granting
permission tome, as Owner, to con struethe
stanructures) and facilities detailed on the submittals reviewed by the
Building Division. In consideration of the i suce of the Building Permit, I agree that I and my agents will comply
with provisions of any federal, state or to I law regulating the work and the Garfield County Building Code, OWTS
regulations and applicable land use regula ons (County Regulation(s)). 1 acknowledge that I 'a rmit
may be suspended or revoked, upon notice from the County, if the location, construct! or use of the str tures)
and facil'ty(ies), described above, are not in ompliance with County Regulatian(s) or ny otoler applicable aw.
I hereby rant perm€ssion to the Building Di 'sion to enter the property, desc 'bed ove, t inspect the ork. I
further a knowledge that the issuance of th Building Permit does not preven the uilding ff€cial fro : (1)
requiring' he correction of errors in the sub ittals, if any, discovered after iss ane • or (2) s upping nstruction
or use of t e structure(s) or facility(ies) if suc
Review of t is Application, including submitt
constitute a acceptance of responsibility or
Owner, l ack wledge that responsibility for
rest with me a d my authorized agents, inch
builder.
1 hereby ackn edge that l have read
have provided t it Informatioi
Sign
€s €n v€ola f County Regula on(s) r any Cher plicable law.
s, and i spte ion of the work b the B ilding i sion do not
abili Uwith
of errors, a ission r ' crepancies. As the
,mpli al, state an local la a County Regulations
ing wimy architect designer, ngineer and/ or
id unNotice and Certification above, as well as,
Which accurate to the best of my knowledge.
�.,,_
Date
'OFFICIAL USE ONLY
Special Conditions:
Adjusted Valuation:
Plan Check Fee.
P rmit Fee:
Manu home Fee:
Misc Fees:
Total Fees:
Fees Paid:
11
Balance Due:
SP No:
91JO
OWTS No:
Setbacks:
OCC Group:
Const Type:
rND
BUILDING /PLANNING DIVISION :
Signed Approval
Date
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