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. . ,. .Glenwood SPrings, CO 81601
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Community Development Department
TYPE OF CONSTRUCTION
tr Commercia ulti-Family
INVOLVED PARTIES
tr Demolition
tr Manufactured Home SF or Du
Reroofor TownhomeResidentialtrFDu
Property Owner:
Mailing Address:
[]hone:
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t'2
Contractor:
-
'Fhon
Mailing Address:
)e:(
(_)t
¿r;'
l,'Í/ne
Maiiing Address
Architect:
G
E AlterationClass of Work:E New E Rddit¡on
E Rttached
Engineer:
Mailing Address:
Manufactured Home lnstaller:
Mailing Address:
Assessor's Parcel Number: ?ì1T.þlCL@Q=suU.
Owner's Valuation of Work: S-
LO
lot ? elock Ç
Height:
:munity
xSq.Ft of Building ,4tfi/J
'aa lr tr Move/Relocation
1,' .rched
Sq.Ft or Acres):
S of Floors
PROJECT NAME AND LOCATION
Describe Work:
Job Address:
tr ISDS
Garage:
Septic:
E otherElectricE Propane
flNaturalGasType of Heat:
Driveway Permit:E Exempt Pe 'init #
-oÌl
NOTICE
nuifroi¡iv, fhiiapplicat¡onforaBuildingPermitmustbesignedbytheOwnqroftheproperty,describedabove,or
anauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterof authority,signedbythe
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 perm¡ts. Multiple separate permits may be requirecl:(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.
Voidpefmtt.ABuildingPermitbecomesnull andvcidiftheworkauthorizedisnotcommencedwithinl80daysof
the date of lssuance and if work is suspended or abandoned for a period of 1.30 days after commencement.
CERTIFICATION
I hereby certify that I have read this Application and that the inform
understand that the Building Division accepts the Application, along
data submitted by me or on my behalf (submittals), based upon my
completeness of the submittals and approval of this Application, a Building itqrmit will be issued granting
permission to me, as Owner, to construct the structure(s) and facilities detaii':d on the submittals reviewed by the
Building Division. ln 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 Sarfield County Building Code, ISDS
regulationsandapplicablelanduseregulations(CountyRegulation(s)), lac!:,.ewledgethattheBuildingPermit
may be suspended or revoked, upon notice from the County, if the location- :lnstruction or use of the structure(s)
and facility(ies), described above, are not in compliance with County Regula:.'^n(s) or any other applicable law.
I hereby grant permission to the Building Division to enter the property, des';r'i5ed above, to inspect the work. I
further acknowledge that the issuance of the Building Permit does not preveÍ':i 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 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 Building Division do not
constitute an acceptance of responsibility or liability by the County of errors,.:rmissions or discrepancies. As the
Owner, I acknowledge that responsibility for compliance with federal, state and local laws and Couilty Regulations
rest with me and my authorized agents, including without limitation my archilect designer, engineer ancj/ or
bu ilder
I hereby acknowledge that I have read and understand the Not¡ce and Certification above as well as
have provided the requi red information which is correct and accurate to the best of my knowledge
2
Property Owner Print d Sign Date
at¡on cÕntained above is true and correct. I
with the,plans and specifications and other
certificafion as to accuracy. Assuming
Manu hom.'.:.lee:
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c
OFFICIAL USE ONLY
Special Conditions:
Misc Fees:
t'.r ll\Perm¡t Fee:
1¡,ln mPlan Check Fee
i,\) lË
Adjusted Valuation
l\', / lQ
NllÀ1
ISDS Nb:BP No: .
?.Y]tr
Baf ance pue;ra
i ,{;/, ( 1./q:'iöÀ o"ry'/ä'o..
.t2üZoningConst Type:
:LELOCC Group:fn c-N lt2
Setbacks:
BUILDING / PLANNING D¡VISION
Signed Approval
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Date