HomeMy WebLinkAboutApplicationpUG z61"'
Garfield County
Community Development Department
108 8" Street, Suite 401
Glenwood Shrines. CO 81601
(970) 945-8212
www.earfield-countv.com
I YPE OF CONSTKUC TION
❑ Commercial/Multi-Family
❑ Manufactured Home (SF or Duplex)
• Rsacifirantiai (SF rlunipr nr Tnwrhnrr:¢1 pl. PPrnn#
BUILDING PERMIT
APPLICATION
0 Demolition
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Mailine Address:
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VIM* lite
MaiIiina Addross7
At
Mailine Aririreme•
Engineer: rnt�nir= 1
Mzitine &A,lrncc•
ivianu actureu Home instaiier: rnone: t
Il/I�i�ina Arirlracc•
PROJECT NAME AND LOCATION
Describe Work: �C+� i'ri i �� old Aron )2L-1-17 r}i c) Y1Y5 Ci `7
Job Address:j�
�)`; C.:4%�xrlAi il 9%v it, '-tl ���--1S-ice l' -c: �'jl(Oy
Assessor's Parcel Number: Sub. Lot Block
%Ali*t.ti. 5 i...i.c7ai.;i.. i,. 11104..1 n•
. 1004.1 t
Sa.Ft of Buildine: aQ oc Heieht: # of Floors: j
Class of Work: 0 New j ❑ Alteration ❑ Addition 0 Repair 0 Move/Relocation
Garage: 0 Attached 0 Detached
Septic: 0 ISDS 0 Community
Type of Heat: 0 Natural Gas 0 Propane 0 Electric 0 Other
Driveway Permit: 0 Exempt 0 Permit #:
NOTICE
Authority. This 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.
Legal Access. A Budding 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 ISDS 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
1 nereoy certify that i nave read this Appiicatlon 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 and other
data suomittea oy me or on my oenaif (suomittais), eased upon my certification as to accuracy. Assuming
completeness of the submittals and approval of this Application, a Building Permit will be issued granting
permission to me, as owner, to construct the structure(s) arid facilities Cietalled Oh the suDmittais reviewed Dy the
Building Division. In consideration of the issuance of the Building Permit, I agree that I and my agents will comply
wiur provision 0t atiy ieuei-ai, snare or 10Cai iaW regulating die WOE acid Ilio vet flew l,Ouniy OWIdirig Lucie, iJUJ
regulations and applicable land use regulations (County Regulation(s)). I acknowledge that the Building Permit
may Ue suspended Lir ievoikeo, upoir r10tite i10111 We county, tithe location, COrIStrut.iioii ur use of Lite siruCtutels)
and facility(ies), described above, are not in compliance with County Regulation(s) or any other applicable law.
1 tieredy grant peinriSSiui1 to lite Dom:ring tiiliISiuii t0 C11tl5 tiie iii Opei-ty, CitSCl ueU a)Ove, CO ii-isiieC1 Olt WOlk.
further acknowledge that the issuance of the Building Permit does not prevent the Building Official from: (1)
teLUiiniig Cite Lui leLituli 01 et tuts iii Lite Suuiiliiiais, n alit', UISLUV CieU aliel issudULe, 01 ict si0 iflits L0lI Li Ul,iiOit
or use of the structure(s) or facility(ies) if such is in violation of County Regulation(s) or any other applicable law.
liCVit VV 01 Li1iJ f`iiiiii1La Uiil t, ii1(.lUU11% SU J U.d;J, a1114 i ispecuuits 01 Lilt INUIK fly Lilt 011111111% UlVtsiuti UO 1101
constitute an acceptance of responsibility or liability by the County of errors, omissions or discrepancies. As the
iiic3t le4fLiiiJiiilviiy Loi LW ifiJiicxiiLC Whit teUCic:Y i .Bili ZC dii:Li iui.ai id iPtS Quo l.iiiJtiiy riCSUid LiLl is
rest with me and my authorized agents, including without limitation my architect designer, engineer and/ or
4Y1ty.Gf .
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provide,equired information which is correct and accurate to the best of my knowledge.
Ay
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OFFICIAL USE ONLY
Special Conditions:
Adjusted Valuation:
Plan Check Fee:
Permit Fee:
(C
Manu home Fee:
Misc Fees:
Total Fejees:
l
Fees
Paid:
Balance ue:
BP No:
ISDS No:
Setbacks:
OCC Group:
Const Type:
Zoning:
F,
BUILDING / PLANNING DIVISION
: �i I1
e_ ,l ,,,, ((,
Signed A r
val Date
I 1 0D) V 003/ x'124 (t