HomeMy WebLinkAboutApplicationGarfield County
31p%immunity Development Department
WOV 108 8'1` Greet, ajite401
Glenwood Springs, 0081601
(970)945-8212
www.garfieId-caunty.com
TYPEOFOONSIFIAXTION
KF Commercial/Multi-Family T p8 Demolition
_ ^` anufactured Home Sn a or Multi -Level.}
UY Feddential (S= Duplex orTownhome) '� Reroof
INVOLVED PARTIES - — -
Property Owner: V#OloO T. /Z D p31 V-6 Phone: 70 9 yg - S$ /
Mailing Address: qI (—Ie- //3 , 011--4161D.014 In S /67,3 _
Email Address:_'iryl1;71fe-d&V4 VL)7 r
Contractor:
Mailing Address:
Phone: (�
Email Address:
Architect:
Phone: ( )
Mai I ing Address:
Snail Address:
Engineer:
Mailing Address:
Phone:
Email Address:
Manufactured Home Installer:
M ai I i ng Address:
Phone:
Email Address:
!i PST NAM EAND L=-noN _
Describe Work: dry P��i r�7
,bb Address:% C12- //,3 ��CiDf}�►/6
Assessor's Parcel Number: Z8cj31 noxa `f`t Sib. Lot Block
Owner's Valuation of Work1w Property Sze (5�. R. or Acres):
gl. R. of Building: 44.7 Height: �.' / #of Floors: /
Oassof Work. ®1516w p= teration we dition Pa Fbpair Move(%location
Garage:
optic.
Type of Heat:
Driveway Permit:
Detached
ural Gas I L IR'opane I LJBecdric
N0110E _
Authority. This application for a Building Formit 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 Building Permit cannot be issued without proof of legal and adequate accessto the property for
purposesof inspections by the Building Division.
Other Permits. Multiple separate permits maybe required: (1) Rate Bectrical Permit, (2) County OVVTSFormit,
(3) another permit required for use on the property identified above, e.g. Sate or County highway/ Fbad Access or
a Rate Wastewater Discharge Psrmit.
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. '
CERTIRCAMON
I hereby certify that I have read thisApplication and that the information contained above istrue and correct. I
understand that the Building Division aoceptsthe 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
permission to me, as Owner, to construct the structures) 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 agentswill comply
with provisions of any federal, state or local law regulating the work and the Garfield County Building Code, OVVTS
regulations and applicable land use regulations (County Fegulation(s)). I acknowledge that the Building Rormit
may be suspended or revoked, upon notice from the County, if the location, construction or use of the structure(s)
and facility(ies), described above, are not in compliance with County Fegulation(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 Official 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 fadlity(ies) if such is in violation of County Fegulation(s) or any other applicable law.
Feview of thisApplication, including submittals, and inspectionsof the work by the Building Division do not
constitute an acceptance of responsibility or liability by the County of errors, omissions or discrepancies. Asthe
Owner, I acknowledge that responsibility for compliance with federal, state and local laws and County Fbgulations
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.
A'231/�'
Property Owner Print and Sign Date
OMML USEONLY
Special Conditions
Adjusted Valuation:
01I15r
Ran Check Fee:
Permit Fee:
Manu home Fee:
Misc Fees:
46Z.00
0,04-'a4
32-1.7s
—
—
Total Fees
�2 1 q4. 01
Fees Phi d:
Balance Due:
l 0�� �3
BP No:
pl � c__ggT
ONTSNo:
it --L E SI3
Setbacks
F/R • = 25 S =10
OOCGroup:
(RG
Const Type:
I RG
Zoning:
BUILDING/ PLANNING DIVISION :
111111-7
Signed Appw
Date
p6 ,a �11i-n-.1 c&'J IIIT3110
Gn���Irf Cvt+nr3�
BuildigtZonin PhanReview Chea i'51L
Permit N umber: Mge - 11-1f ,-4517
/
Building Planning/ Zoning,
Engineered Foundation Property tine Setbacks
Driveway Permit WA 30 ft. Stream Setbacks
Surveyed Site Plan
Septic Permit and Setbacks
Grade/ Topography 30%
r Attach Residential Plan Review List
WA Subdivision Plat Notes
WA Flood Plain
Building Height
/ Zoning Sign -Off
N`A
Fire Department Review
/
Road Impact Fees
Valuation Determination/ Fees
Grade/ Topography 40%
Red Line Plans/ Stamps/ Sticker
!
Planning Issues
X
Attach Conditions
Application Signed
Plan Reviewer to Sign Application
Parcel/ Schedule No.
WA
. 409 Snowload Letter— Manu. Homes
X
Solis Report
WA Flood Plain
Building Height
/ Zoning Sign -Off
N`A
Road Impact Fees
Grade/ Topography 40%
!
Planning Issues
X
Subdivision Plat
General Comments:
pout < vkv f 1 & x� _ '70
stvr 1.10Pv ksl,v jo 6oX -4e = 2, Geo
gob ?o tAl X48
CW,164449-5?
\,la.f v4L.-hb V1 = 12168 1 9962 .
,pWxjliti�j, Lh�f
6woray1krk5koo
Cvuw,O PM-
746x74-,$- 57j354.
21wx 3z: 121((-o
and/or plans for compliance, the application may be placed on hold until the required information is
provided. Work may not proceed without the issuance of a permit.
The Building Division will collect a Plan Review fee at time of application submittal. The permit fee, as
well as any Road Impact fees will be collected when the permit is issued.
The permit application must be signed by the owner or by person having written authority from the owner
to act as their representative.
Building cannot be occupied until a Certificate of Occupancy (CO) is issued. Using the building wimou_
CO will be considered an illegal occupancy and may be grounds for vacating the premises. (Final/CO
inspection requirements will be attached to your approved field set of plans.)
I hereby acknowledge I have read, understand and will abide by the requirements of this
checklist.
Property Own int and Sign
//-23 - /�0
Date