HomeMy WebLinkAboutApplicationGarfield Co
ty
Community Development Deparli,wnt
µoV fl i tta 108 8'h Street, Suite 401
Glenwood Springs, CO 81501
(970) 945-8212
www.aarfieid-county.com
TYPE OF CONSTRUCTION
❑ Commercial/Multi-Family
0 Manufactured Horne (SF or Duplex)
❑ Residential (SF, Duplex, or Townho
INVOLVED PARTIES
Property Owner Clei-2-1\14.E.
Mailing Address: &90 eiP-OO ILt
Contractor. ecc
Mailing Address: 9 . Q),
Architect:
Mailing Address:
Engineer:
Mailing Address:
BUILDING PERMIT
APPLICATION
1 ❑'1 Demolition
e 1 lel Reroof
Phone: (402,
Phone: 910 ) 4�� 1-3 hl -
213 C-��Cr1k s , Cr) 1 0l.
Phone: ( )
Manufactured Home Installer:
Mailing Address:
PROJECT NAME AND LOCATION
l_yr_
Phone:( )
Phone:
Describe Work R go"{we
uSE- 6N 696 g.(,t.
Job Address:
6.7p 5R-doK-
SLS
I Assessor's Parcel Number,
Sub.
Owner's Valuation of Work $ i; t(,
Sq.Ft of Building:
Class of Work: : ❑ New 0 Altera
Garage: 0 Attached
Lot Block
S Property Size (Sq.Ft or Acres):
eight # of Floors:
i ❑ Addii on
Septic: ; 0 ISDS
! Type of Heat: ttiNaturaiGas
Driveway Permit: ' ❑ Exempt
0 Propane
0 Repair a ❑ Move/Relocation
❑ Detached
0 Community
" 0 Electric 1 0 Other
i
i ❑ Permit #:
NOTICE
Authority. This application for a Building P
an authorized agent. If the signature below
Owner, must be provided with this Appllcat
).vital Access. A Building Permit cannot be i
purposes of inspections by the Building DM
QtheiPermits, Multiple separate permits
another permit required for use on the pro
State Wastewater Discharge Permit.
Vold Permit, A Building Permit becomes nu
the date of issuance and if work is suspende
11 -CERTIFICATION
t must be sign
of that of the
without pro
be required:
identified ab
dvoid ifthe
abandoned
d by the Owner of the property, described above, or
er, a separate letter of authority, signed by the
f of legal and adequate access to the property for
State Electrical Permit, (2) County ISDS Permit, (3)
ve, e.g. State or County Highway/ Road Access or a
rk authorized is not commenced within 180 days of
a period of 180 days after commencement.
I hereby certify that I have read this Appli
understand that the Building Division accep
data submitted by me or an my behalf (sub
completeness of the submittals and appr
permission to me, as Owner, to construct th
Building Division. In consideration of the iss
with provisions of any federal, state or local
regulations and applicable land use regulati
may be suspended or revoked, upon notice
and fadlity(Ies), described above, are not in
I hereby grant permission to the Building 0i
further acknowledge that the issuance of th
requiring the correction of errors in the sub
or use of the structure(s) or faciiity(ies) If su
Review of this Application, including subm
constitute an acceptance of responsibility or
Owner, I acknowledge that responsibility for
rest with me and my authorized agents, incl
builder.
I hereby acknowledge that I have read
have provide,the required Informatlo
,2,
and that the i
e Application,
Is), based up
this Applicati
ucture(s) and
of the Build
regulating th
County Regul
the County,
pliance with
n to enter the
Iding Permit
Is, if any, di
in violation o
and inspectio
ility by the Co
pliance with
g without lim
formation contained above is true and correct. I
long with the plans and specifications and other
my certification as to accuracy. Assuming
a Building Permit will be issued granting
ciiities detailed on the submittals reviewed by the
g Permit, I agree that 1 and my agents will comply
ork and the Garfield County Building Code, ISDS
ion(s)). 1 acknowledge that the Building Permit
the location, construction or use of the structure(s)
unty Regulation(s) or any other applicable law.
roperty, described above, to inspect the work. I
es not prevent the Building Official from: (1)
ered after issuance; or (2) stopping construction
nty Regulation(s) or any other applicable law.
of the work by the Building Division do not
nty of errors, omissions or discrepancies. As the
deral, state and local laws and County Regulations
tion my architect designer, engineer and/ or
d understan
ich is co
the Notice and Certification above as well as
and accurate to the best of my knowledge.
Property Owner Print and Sign
Date
OFFICIAL USE ONLY
Special Conditions: '
Adjusted Valuation:
Man check Fee:
Pe ,'
Mann home fee:
Misc Fees:
Total Fees:
1 ,----
Fees Paid:
6)) --�
.
Be Due:
T.DF-
I22/111a:
u
OCC Group:
Con
t Type:
Zona
BIIILOMNG j PLANNING DIVISION : (11
�i9-
,LO
_....
I lL
• - . l
Date
IC' 1111-1'1R+o