HomeMy WebLinkAboutApplication' . Garfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfield-countv.com
f TYPE OF CONSTRUCTION ---
CJ Commercial/Multi-Family
[J Manufactured Home (SF or Duplex)
'b Residential (SF, Duplex, or Townhome)
CJ Demolition
~ Reroof
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INVOLVED PARTIES
-i
Property Owner: _K_e_rry_M_cC_a_rth_Y __________ Phone: ( 970 ) 987-7591
Malling Address: 746 Panorama Or., Carbondale, CO 81623
Contractor: 11tgn ? cuCT1 \:. 2m<1, 'j Phone:< 91-P) i3C -1$ b 1
Malling Address: Q. a \ov}. 2)1\ q\m"vooJ ·s~~sf> CQ ~\ bO"i
I Architect: _________________ Phone:(._ _ ___, _____ _
Mailing Address: _________________________ _
Engineer: _________________ Phone:._( _ ___,, _____ _
Malling Address: _________________________ _
Manufactured Home Installer: ___________ Phone:._( _ ___, _____ _
MalllngAddress: _________________________ _
PROJECT NAME AND LOCATION
Describe Work:~ ]r0 io q q)ei$ 0-:-1".(c b·nrrt OlCC et.>+,-qj
[V}]kc)ol~ 60m·.ls-T.f.O Q<cc= Q,:n~ <Ucci;. I
Job Address: 7/'fo B:hocamq d c <1-nc~ol c Co I ':!.I G :? r
Assessor's Parcel Number: Sub. Lot Block
Owner's Valuation of Work: $ (/ 1410. 0 0 Property Size (Sq.Ft or Acres): ____ ...;
Sq.Ft of Building: i, 14 Co Height: #of Floors:, ____ _
Class of Work: CJ New f 0 Alteration CJ Addition
Garage: D Attached
Septic: l [J ISDS
Type of Heat: I D Natural Gas
l!J Repair [J Move/Relocation
! D Detached
D Community
CJ Electric T CJ Other
t
Driveway Permit: 0 Exempt
~ ---1 -
I CJ Propane
T .l D Permit#: ______ _
L_
L
I NOTICE - - -
I
Authorltv. This application for a Building Permit must be signed by the Owner of the property, described above, or l
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.
leg! 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 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.
Vold 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 ls suspended or abandoned for a 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. I
understand that the Building Division accepts the Application, along with the plans and specifications and other
data submitted by me or on my behalf (submlttals), based upon my certification as to accuracy. Assuming
completeness of the submlttals and approval of this Application, a Building Permit will be issued granting
permission to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by the
Building Division. In consideration of the issuance of the Building Permit, I agree that I and my agents will comply
with provisions of any federal, state or local law regulating the work and the Garfield County Building Code, ISDS
regulations and applicable land use regulations (County Regulation{s)). I acknowledge that the Building Permit
may be suspended or revoked, upon notice from the County, if the location, construction or use of the structure(s)
I and facflity(ies), described above, are not In compliance with County Regulation(s) or any other applicable law.
I hereby grant permission to the Building Division to enter the property, described above, to inspect the work. I
further acknowledge that the Issuance of the Building Permit does not prevent the Building Offlclal 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 other applicable law.
Review of this Appllcation, includlng submittals, and Inspections of the work by the Building Division do not
constitute an acceptance of responsibility or liability by the County of errors, omissions or discrepancies. As the
Owner, I acknowledge that responsibility for complfance with federal, state and local laws and County Regulatfons
rest with me and my authorized agents, including without limitation my architect designer, engineer and/ or
builder.
I hereby acknowledge that I have read and understand the Notice and Certification above as well as
have provided the required Information which Is correct and accurate to the best of my knowledge.
_)'(Ir~ 11/3/2016
Property Owner Print and Sign Date
OFFICIAL USE ONLY
Special Conditions:
Adjusted Valuation: Plan Chedc Fee: Mani.I home Fee: Misc Fees:
11.4.1ee
Date