HomeMy WebLinkAboutApplicationGørfield CountY
BUILDING PERMIT
APPLICATIONCommunity Development Department
tOg gth Street, Suite 401
Glenwood SPrings, CO 81601
(97Ole4s-8212
www.ga rf ield-cou ntv.com
INVOLVED PARTIES
Property Owner:
Mailing Address:
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Email Address:{
Phone: W, OV+-tUOO
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TYPE OF CONSTRUCTION E DemolitionCommeFam
E or MultiManufactured Home n
ReroofResidential (SF,lex or Townhome
MairingAddress' 'SNEñùQUÙ5 S\0 \4c E (lV-*ÀÀs€'i\Þq,C;r
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Contractor:Ì\l'\\r\o -.. rñÀ/r¡^r
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Phone: tf to I 1 H 5- TfO-â
Email Address:
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Phone: t l7o I 4A 5 -+5 r¡L
Mailing Address
Architect:
Email Addressr
Phone:
+Mailing Address:
Engineer
Manufactured Home lnstallerl
Mailing Address:
Email Address:
Phone: (
I Move/nelocation! Repairfl¡da¡t¡on[lAlterationNewtrClass of Work:
DetachedAttachedGarage
PROJECT DETAII-S
Describe Work:\<Þ
Job Address:
Assessor's Parcel Number:
lot
-
Block
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5ub.
owne/s valuation of work: s Property size (sq. Ft. or Acres)r
Sq. Ft. of Building:150 Height:# of Floors:-
! Community
Other! etectri.Propane$ruaiuratcas
Exempt
Type of Heat:
-ö¡uã."v Perm¡t:
PROJECT DETAITS CONTINUED
Septic:OWTS
Perrnit #:
NOTICE
Authoritv. This a pplication 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'
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 p"rtit, 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 n
of the date of issuance and if work is suspe
ull and void if the work authorized is not commenced within 180 days
nded or abandoned for a period of 180 days after commencement'
CERTIFICATION
I hereby certify that I have read this APPI ication and that the informati on contained 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
comp leteness of the submittals and approval of this Appl ication, a Building Permit will be issued granting
perm ission 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 Provisio ns of any federal, state or local law regul ating 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 sus pended or revoked, uPon notice fro m the County, if the location, construct¡on or use
of the structure(s) and facility(i es), 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 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' 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
desi e or builder
I hereby acknowledge that I have read and un derstand the Notice and Certification above, as well as, have
provided the required information which is correct and accurate to the best of my knowledge'
Property owner Print and s¡gn Date
OFFTCIAL USE ONtY
Special Conditions:
Misc Fees:Manu home FeeFee:Plan Check Fee:Adjusted Valuation:
OWTS No:BP No:
-5Balance Due:_ê*Fees Paid:
2s.¿ÍôTotal Fees:
Zonin94Ktt6lConst TyPe:OCC GrouP:Setbacks:
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BUILDING / PLANNlNG DIVISION
Signed APProval Date