HomeMy WebLinkAboutApplication$CANl'¡ED b*rtcfàK
Community Development Department
RE,e EIVED 1OB 8th Street, Suite 401
Glenwood Springs, CO 81601
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GARF IELD COUN
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Garfield County
BUILDING PERMIT
APPLICATION
DemolitionE Commercial/Multi-Family
Reroof
Manufactured Home
Residential
or Multi-Level)
or Townh
(_Phone:
YI
0 3e4V4
Email Address
Property Owner:
Mailing Address:
IPhone:(contrector:
Mailing Address:
Email Address:
Mailing Address:
I
\",(_)Architect:
Email Address
Phone: f )Engineer
Mailing Address;
Email Address:
Mailing Address:
Email Address:
Phone:Manufactured Home lnstaller:
Describe Work:
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ILot
Pe- Ro .s
Height:2o'#of
e,(
of Work:
Job Address:
Assessol's Parcel Number:
Sub.
Property Size (Sq. Ft. or Acres):Owner's Valuation
Sq. Ft. of Building:
Block _
ll Move/Relocation[ ruew ! Alteration I-l a¿¿¡t¡on RepairClass of Work:
Attached DetachedGarage:
DETAILS CONTINUED
Septic;OWTS Commr.rnity
Type of Heat:Natural Gas Propanc EI Iotrer
Driveway Permit:Exempt Permit #:
NOTICE
Author¡tv. This application for a Building Permit must be signed by the Owner of the property, described above,
oranauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedby
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 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.
CERTIFICATION
I hereby certify that I have read this Application and that the information 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
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 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 submìttals, if any, discovered after issuance; or (2) stopp¡ng
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
e ineer and/ or builder
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
p rovided the required information which is correct and accurate to the best of my knowledge.
Property Owner nt and Date
r,
OFFICIAT USE ONtY L t &þo.c5ì) r^z cc_
Special Conditions:
Adiusted Valuation:' lJllþ
Plan Check Fee:
t¿t t4
Perm¡t Fee:
&lÒo.r5>
Manu home Fee:
iJ IA
Misc Fees:N(A
Total Fees:
SloP'ÒP
Fees Paid:
$ l?r.uo
Balance Due:
Ð-
BP No:
øouç Á5q?þ
OWTS No:
-tç[Asetbacks¡ N ( A
oCC Group: f&L Const Type:TLL Zoning:
þIr,uÞrf
þsþlrrBUILDING / PI.ANNING DIVISION :
Signed Approval Date