HomeMy WebLinkAboutApplicationî6
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108 8'h Street, Suite 401, Glenwood Springs, CO I t 601
P h : 9 7 0-9 4 5 -82 I 2 Fx : 97 0- i 84-3 440 Inspection Line : I I 8-8 6 8-5 3 0 6
www. garfi eld-county. com
BUILDING PERMIT APPLICATION
Garfiefd Coe¿rz
I Parcel No: hhis information' " Atll the¡s 34)Lot No: Block No: Subd./ Exemption:
2 has nol been ot Slreet Name & Cily) or andlegal description1'Job an provide'3
LOwner: (nronertv owner\ t
D.od; 4í...'Rv+rJ
Mailing Address:Ph:qBç -T3zo AltPh:
Mailinu Adtlress:?b Bo¡< zz3 Ph:4to -bzr-ff?o o4l.)'.-eß -L6t?4 Contractor: -
4 lA u Þ,¿¡ttAN V.-ø h.-A
5 Manufactured home installer:Mailing Address:Ph:Lic#:
6 Architect:Mailing Address:Ph:AIt Ph:
7 Engineer:Mailing Address:Ph:AIt Ph:
Sq. Ft. or Acres oflot:Heisht:" ls-brw No. of Floors:I of Buildins:-a rooi{'Sq. Ft.
l?
9 Use of Buildins: t
IMesidential lCommercial lOther lNcw MAlteration lAddition flRepair [Demo EMove
Class of Work:
l0 Describeto'o'È".o vz,r ?+oL J,4¡t wit| Soyr arrl"ikJ.r^( tl*)tqbs
DISDS lCommunity
Septic:
[Nat. Gas EP¡opane nElectric Eother
Type ofHeat:11 Garage:
EAttached EDetached
owners valuation of work, p - ltra t øot:-w&";*l12Driveway Permit:
NOTICE
letter of authority, signed by the Omer, must be provided with this Application.
LegalAccess. ABuildingPãmitcmãtbeissuedwithoutpioofoflegalmdadequateaccesstothepropertyforpurposesofinspectionsbytheBuildingDeparment.
Comty Highway/ Road Access or a St¿te ìVastewater Dischuge P€mit
VoidPermit ABuildingPemitbecomesnullædvoidiftheworkauthorizedisnotcomencedwitþinlS0daysofthedateofissumcemdifworkissuspendedorabmdonedforaperiodoflS0
daYs after comencement' ¡FDTrF'ñ^T
md specifications md other data submitted by me or on my behalf (submittals), based upon my certification æ to accuacy.
the submittals reviewed by the Building Departnent.
construction or use of the structrre(s) æd facility(ies), described above, re not in complimce with Comty Regulation(s) or æy other applicable law.
of Couty Regulation(s) or æy other apþlicable law.
limitation my rchitect designer, engineer md/ or builder.
I FIEREBY THAT I HAYE READ AND UNDERSTAND T}IE NOTICE &TIONABOYE:
DATEOWNERS SIGNATURE
b .15'r
ct<- À+ãq ül0o STAFF USE ONLY
Special Conditions:
Permit Fee:
ì00
Manu home Fee:Misc Fees:_Adjusted Valuation
)ró0. -
Plan Check Fee:
Balance I)ue:
tob
!!$ & Issuc Date:
?oot- E,làÀ
ISDS No & Issued Date:Total Fees
loo
Fees Paid
t0o
OCC Group:Const Type:Zoningz
R
Setbacks:
t\
DATE
BLDGDEPT:
APPROVAL
PLNG DEPT:
APPROVAL DATE