HomeMy WebLinkAboutApplicationGørfield Counþ
Community Development Department
APR i I ?017 1og 8'n street, suite 401
Glenwood Springs, CO 81601
ls7ol94s-8212
www.garfiel d-cou ntv.com
BUILDING PERMIT
APPLICATION
WPE OF CONSTRUCTION
tr Commercial/Multi-Family tr Demolition
tr Manufactured Home (SF or Duplex)
E Residential ¡(9þDuplex, or Townhome)I Reroof
INVOLVED PARTIES
Property Owner:
Mailing Address:
Phone:
'{
Mailing Address:
Contractor:
Phone: (_)
Mailing Address:
Architect:
Engineer:Phone: ( )
Mailing Address:
Manufactured Home Installer:Phone: I )
Mailing Address:
PROJECT NAME ANE TOCATION
Assessor's Parcef N umber: QAE(49W2_Sub.
Owner's Valuation of Work: S S: ln
Describe Work:
Job Address
Block 3
Sq.Ft of Building:Height:
f-ot ?
Property Size (Sq.Ft or Acres):
# of Floors: I
tr Addition E Repair tr Move/RelocationClass of Work:E New 'EI Alteration
E DetachedGarage:f, Rttached
S CommunitySeptic:tr ISDS
fl ottrerE NaturalGas El Propane E ElectricType of Heat:
E Permit #:Driveway Permit:E Exempt
NOTICE
Authoritv. ThisapplicationforaBuildingPermitmustbesignedbytheOwneroftheproperty,describedabove,or
an authorized agent. lf the signature below is not that of the Owner, a separate letter of authority, signed by the
Owner, must be provided with this Application.
Lesal 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.
VoidPermit. ABuildingPermitbecomesnullandvoidiftheworkauthorizedisnotcommencedwithinl80daysof
the date of issuance and if work is 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 thatthe 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 thisApplication, a Building Permitwill be issued granting
permission to me, as Owner, to constructthe structure(s) and facilities detailed on the submittals reviewed bythe
Building Division. ln consideration of the issuance of the Build¡ng 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)). lacknowledge thatthe Building Permit
may be suspended or revoked, upon notice from the County, ifthe location, construction or use ofthe structure(s)
and facility(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 Build¡ng 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 facility(ies) if such is in violation of County Regulation(s) or any other applicable law.
Review of this Application, including submittals, and inspections of the work by the Build¡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 responsibility 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
have provided the requ¡red information which is correct and accurate to the best of my knowledge.
Property Owner Print and Sign Date
OFFICIAT USE ONLY
Special Conditions:
Adjusted Valuat¡on:
N\/R
Plan Check Fee:
N\ /Ê 'wäö o"Manu home Fee
ìl..lilq
Misc Fees:N/e
Total Fee's:atoo @ Fees P'aid:
$)oo,oo
Balance Due
6c,oo
BP No:
?crF- \rto8(o
ISDS N6:
rl'¡lFl
Setbacks:
ír /n
OCC Groupyi-Ì_Const Type:
TVvtt
Zoning:
Puo
tr.rg l7BUILDING / PLANNING DIVISION
Signed Approval Date