HomeMy WebLinkAboutApplicationc:e Garfield County
Community Development Department
108 9th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www .garfield-county.com
TYPE OF CONSTRUCTION
D Commercial/Multi-Family _ _ ____ D Dem_o_liti~!I ___ _
D Manufactured Home (SF or Duplex)
~Reskfe ntial-(SF,-Du pi;;. o r Townhome )'"------~Reroof
I INVOLVED PARTIES -=-__ _ _
l Property Owner:. (}M _{ p..., ;!of/.vwN'
Mailing Address: 3os=1 b4 ~ ""i o_;, ..
Contractor-:-iT/f;U )?IJCft° W foou/,/'f t,.ve_. Phone: ( '110 ) '/StS-'{95~ 7 1
Mailing Address: P,o · 80). :Z3t3 l;tewt460o ~"'-~~ &!A>MrJo ~_f(,o~ _j
Architect: _________________ Phone:(--~-------
Mailing Address:
~~~~----------------------
Engineer: Phone: ( __ ------
Mailing Address: _________________________ _
Manufactured Home Installer: ___________ Phone:(~-~------
1 MailingAddress:....,.... ____________________ __,__ __ --=--
~ROJECT NAME AND LOCATION
Describe Work: \oc ef~\\r-. -;)•'~ eek ~..i\d~c~ ) \"';:b\I !)cul
I) f 'W. ~ ~ ~t C1Q ~, \er•..,· <>\-C'=.bJ.-\1 l\<a ~ a--do\i
JobAddress:"3o21 ~ ~~03
Assessor's Parcel Number: f(OfB(,(,Z,, Sub. Lot Block _,
Owner's Valuation of Work: $ ~1-t'JO · o-c::> Property Size (Sq.Ft or Acres): . . ,
Sq.Ft of Building: l '2 &-0 Height: "?o ""'° · # of Floors: Z-=-I
Class of Work: D New D Alteration-rD Addition JSdiepair l D Move/Relocation -~1
Garage: D Attached D Detached
Type of Heat: D Natural Gas D Propane
D Community
1 D Electric
Septic: OISDS __ 1
D Other
l Driveway Permit: I D Exempt D Permit#: -------
Authorjty. This application for a Building Permit must be signed by the Owner of the property, described above, o r
an authorized agent. If the signature below is not that of the Owner, a separat e letter of authority, signed by the
Owner, must be provided with this Application.
LePI Agess. A Building Permit cannot be issued without proof of legal and adeq uate access to t he property for
purposes of inspections by the Building Division.
Other Pennlts. Multiple separate permits may be required: (1) Sta te 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 Buflding Permit becomes null and void if the work authorized is not commenced within 180 days o f
the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement. -~E~~ICATION
• 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 (submittals), based upon my certification as to accuracy. Assuming
completeness of the submittals and approval of this Application, a Building Permit will be issued granting
l 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 Sand my agents will comply
I 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 Regula t ion(s)). I acknowledge that the Building Permit
I may be suspended or revoked, upon notice from the County, if the location, construction or use of the structure(s)
and facility(ies), describe~ above, are not in compliance with County Regulation(s) or any other applicable law.
I I hereby grant permission to the Building Division to enter the property, described above, to inspect the work. I
I further acknowledge that the issuance of the Building Permit does not preve('lt the Build i!1g Official from: (1)
l requiring the cofrectfon of errors in the submfttals, 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 Regu ration(sl or any other applicable law.
Review of this Application, including submittals, and inspections of the work by the Buildi ng Division do not
constitute an acceptance of responsibility or liability by the County of errors, omissions or discrepancies. As the
Owner, I acknowledge that responsibUity for compliance with federal, state and local laws and County Regulations
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
he required lnformation which is correct and accurate to the best of my knowledge.
Nd/"M~ j, 2ol ~
Date
OFFICIAi: USE ONLY
Special Conditions:
Misc Fees: Adjusted Valuatlon: Plan Check Fee: Permit Fee:
o(} Manu home Fee:
tJ ¢;/ tJ. .\-0 '
Total Fees: Balance Due: ~:
-1->!J Cf) -1:> co ISDSNo:
Setbacks: OCCGroup: Const Type:
/J-/O,/{CJ
Signed Approval Date