HomeMy WebLinkAboutApplicationGarfield County
BUILDING PERMIT
APPLICATION
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Community Development Department
t08 8ü Street, Suite ¡l{11
Glenwood Springs, CO 81601
19701945-8212
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El Commercial/Multi-Family Demolition
E Manufactured Home (Single or Multi-Level)
.Pf Residential (SF, DuplexorTownhome)I Reroof
INVOTVED PARTTES
Property Owner:
Mailing Address:
Email Address:
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(-ø monezrq7\ | q8',I -)b*Contfector:
Mailing Address:
Email Address:
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Arch¡tect;Phone: I ì
MailineAddress:
Email Address:
Engineer:Phone: ( )
MailingAddress:
Email Address:
Manufactured Home lnstaller:Phone: ( )
Mailing Address
Email Address:
PROJËCT DETAITS
Describe Work:
Job Address:
Assesso¡'s Parcel Number:-þ .ô10
suø. lTl¿ao QlV fty* lll rot lO Bbck-
Owne/s Valuation of Work:Property Size (Sq. Ft. or Acres):
Sq. Ft. of Building:ZqA.Height:# of Floorsi
Class of Work:flttew l_lAlteration tlRdoit¡on flRepair fl Move/Relocation
Garage:Iettached l_lDetached
PROJECT DETAIIS CONNNUED
I hereby acknowledge that I have read and undestand the l{ot¡ce and Certification above, as well as, have
provided the required information which is corñect and accurate to the best of my knowledge.
T I 3 2 ettT
Property Oruner Print and Sign Date
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I CommunitySeptic:Iowrs
Type of Heat:[_ltrtatural Gas I eropane l_l rlectric I lother
llPermit*:Driveway Permit:Iexempt
NONCE
Authoflw. Thls appllcatlon for a Building Permit must be signed by the Owner of the property, described above,
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.
Legal Access. A Building Permit cannot be issued without proof of legal and adequate access to the propefi for
purposes of inspections by the Building Division.
Other Perm¡ts. Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS 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.
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.
CERNFrcAilON
I hereby certify that I have read this Application and that the information conta¡ned 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
permission to me, as Owner, to construct the structure(s) and facilities detailed 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 Garfield County Building
Code, OWTS regulations and applicable land use regulations (County Regulation(s)). I acknowledge that the
Building Permit 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 Regulation(s) or any
other applicable law.
I hereby grant permission to the Building Divísion 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 (2l'stopping
construct¡on or use of the structure(s) or facilÍty(ies) if such Ís 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, 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.
OFF¡CIAI USE ONTY
Special Conditions:
Adjusted Valuation:tJlÈ Plan Check Fee:
tu /4 Manu home Fee:Fee:6 Misc Fees:ï) ln
Total Febs: ^ót rqn æ $iËÄ,o Balance
"ds
OWTS No:
Lt ln
Setbacks:
$,.\ ln TSö:'Const Type¡
Y"Í7{J.
Zoning:Þr\h
EUrtDtNC / PTANN|NG DtVrStON :
Signed Approval
J
n/a/ i
Date
Cheryl&Co.
I, Carol Thulson, give Eugene Pickett with the Mesa Ridge Townhomes Board of Directors
permission to sign the Building Permit on my behalf for the new roof on my home, located
at,210 S Ridge Ct, Rifle CO 81650.
-6-(
DATE
120 West Sth Street * Rifle, Colorado 81650 * 970-625-4441
hoamgmtcherylco@gmail.com
,l
Thulson