HomeMy WebLinkAboutApplication~ Garfield County
\ ¥, (, Comm;ty Development Department
~\.. G \ t~\~ 108 81
h Street, Suite 401 ~ . ~J !'\nwood Springs, CO 81601 ~r.w-\t.t..O cu 1 ~1~, ·v (970) 945-8212
J •.• n \\'\\i 'l Dt Jc-'www.garfield-county.com
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TYPE OF CONSTRUCTION
0 Commercial/Mult i -Fam ily
D Manufactured Home (Single or Multi-Level)
D Resident ial (SF, Duplex or Townhome)
INVOLVED PARTIES
I D Demolition
I • Re roof
Property Owner: Crv '~ / I .nJ ~lL Phone: ( '110 ) lo 1.S -2l.. t:;" (
Mailing Address: 4 JL/ () ~R ~?n V<·Cl_ .lo 75/{,S-o
Contractor: A {A-J\) 'Pv """AA.i YG,~tZ.'J Pho ne: ( '110 ) lo 1e-t.c..s-+
Mailing Address: ?o "Bo;c 2.. -Z... 5 ~. \+ (._b 81~ r-2-
Architect: .......... Phon e: ( ) .__
Mailing Address : -.........
Engineer: ~ Phone: ( }
Mailing Address : ~ ....::::::;
Manufactured Home Installer:~ Phone: ( )
Mailing Address : ~
PROJECT NAME AND LOCATION
Describe Work: <f-c.,·P r?rt{ t, h...-e I~ f W~ s/..:~tl tiV-4-r el\J h /c..
I I ( I ~t 1 2L.§. f::roe~ ~, '12.rd.~·AfrL.(l\)5 r ~ \ft...u f;:
Job Address : 41 Lf 0 Ce_ S 7-10 1<J ~lo_
Assessor's Parcel Number: ;2I'79,jj.3(]018/ Sub. I Lot Block --j,'!Ob~•,...
Owner's Valuation of Work: $ l 0, l{O O yoro 1"1o 0 r Property Size (Sq. Ft. or Acres):
Sq. Ft. of Building: ~/(}(). 00 Height: #of Floors:
Y/
Class of Work: D New I D Al t eration I D Addition ~epair I D Move/Relocation
Garage: D Attached D Detached
Septic: OOWTS D Community
Type of Heat: D Natural Gas I D Propane I D Electric I 0 Other
Driveway Permit: D Exempt D Permit#:
Jul 011612:55p Alan Duncan Roofing CO 970 625-5191 p.2
Authority. This application for a Building Permit must be signed by the Owner of the property, described above, or
an authorized agent. If the sisnature below is not that of the Owner, a separate letter of authority, signed by the
Owner, must be provided with tliis Application.
Legal Ac:sess. 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 Permit:s. Multiple separate permits may be required: (11 State Electrical Permit, (2) County OWTS Permit,
(3) another permit required for lJSe on the property identified above, e.g. State or County Highway/ Road Acc:ess 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.
CERTIR.CATION
I hereby certify that I have read this Application and that the information contained above Is true and correct. I
understand that the Building Division accepts the Application, along with the plans and specifications a11d other
data submitted by me or on my behalf (submittals), based upon my certif cation as to accuracy. Assuming
completeness of the submictals and approval of this Application, a Building Permit will be issued granting
permission to me, as Owner, to construct the structurets) and facilities detailed on the submittals reviewed by the
Building Divis ion. In consideration of the issuance of the Bu ilding Permit, I agree that I and my agents will comply
with prciv·sions of any federal. state or local law regulating the work and the Garfield County Building Code, OWTS
regulations and applicable land use regulations (County Regulation(s)l. I acknowledge that the Building Permit
may be suspended or revoked, upon notice from the County, if the location, const ruction or use of the structure(s)
and facility(ies), described above, are not in compliance with County Regulation(s) or any oth~r applicable law.
I hereby grant permission to the Bu ilding Division to enter the property, described above, to inspect the work ,
further acknowledge that the issuance of the Building Permit does not prevent the Bu ilding Official from: CU
requiring the correction of errors in the submitta s, if any, disccvered after issuance; or (2) stopping construction
or use of the structure(s) or fadity(ies) if such is in violation of County Regulat1on(sl or any oth~r appli cable law.
Rev·ew of this Application, including submittals. and inspections of the work by the Building Division do not
constitute an acceptance o f responsibility or liability by the County of errors, omissions or discrepancies. As the
Owner, I acknowledge that responsibility for comp li ance with federal, state and local laws and County Regulations
rest w·rh me and my authorized agents, including without limitation my architect designer, enG ineer and/ or
bu'lder.
I hereby acknowledge that \ have read and understand the Notice and Certification above, as wen as,
~ve ~rovided the r~dred information which Is correct and a'c1Jrate to the best of my knowledge.
~ .J:kA?lcure ~· Lorcle. ?.'I 1u.)JJ.Oj6
Property Owner Print and Sign Date
OfFIClAl. US£ ONLY
Spccl31 Conditions:
Adjusted Valuation: Plan Check Fee : Permit Fee: O (.)
IJ jltJO.
Manu home Fee:
Total Fees: (J () Fees Paid: Balance Due:
-:; /'11 PIO (,() io. oo ooF-4'3/3
Setbacks: OCCGroup: ConstT~t:
BUILDING/ PLANNING DMSION : _....{:S......,,.a,..,.'47!:........,J"""""-"!L.._..._.Wt.c..¥-..;>.<.;~ ....... ~.lv'"""""~~lj""---
SiGned Appro11al
Misc Fees:
7-·l·lle
Dilte