HomeMy WebLinkAboutApplicationq \2-rq
Community Development Department
RECEIVEftS e,n Street, Suite 401
c"rn Ì , Glçgwood Springs, CO 81601
.)r,,t. I t. tvi,¿ (9701945_9212
G ARF I E LD C (NShlÙfMrfield-countv.com
COMMUNITY DEVELOPMENT
Gurfield County
BUILD¡NG PERMIT
APPL¡CATION
WPE OF CONSTRUCTION
E Commercial/Multi-Family I Demolition
Manufactured Home n e or Multi-Level)
l-l Residential (SF, DuplexorTownhome)Reroof
INVOLVED PARTIES
Property Owner:
Mailing Address:
Email Address:
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Contractor Phone: &7Òt945-a\oz
Mailing Address:
Email Address:
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nrcn¡tect: A{AP¿¡I¿Phone: (wo I q63- b76o
Mailing Address:z îl æ 2
Email Address:
Engineer:\I Phone:
Mailing Address:
Email Address
Manufactured Home lnstaller:NA.Phone: ( ' )
Mailing Address:
Email Address
PROJECT DETAILS
Describe Work:OL\
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Job Address:(,Á¿A(k)ñÕÁ.{-Ê
Assessor's Parcel Nu mber:
Sub.Lot Block
owner'sValuation of Work: S 5Q I OAO Property Size (Sq. Ft. or Acres):NA
5q. Ft. of Building:Height # of Floors:
Class of Work:! t'tew ll nlteration ll add¡tion l_l Repair | | Move/Relocation
Garage:!attached f l oetached
PROJECT DETAIIS CONTINUED
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided t uired information is correct and accurate to the best of my knowledge.
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Print and s¡enÌtft|.19 ?AA Pl,Ar)Date
CE PO M ScJ*ool-.
I CommunityOWTSSeptic:
flotner! Propane ! ElectricType of Heat:ll Natural Gas
Driveway Permit:Exempt
Authoritv. 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.
Legal 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 requíred: (1) State Electrical Permit, (2) County OWTS Permit,
(3) another permit required for use on the property ídentified above, e.g. State or County Highway/ Road Access
or a State Wastewater Dlscharge 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 1-80 days after commencement.
Permit #
NOTICE
CERTIF¡CATION
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 constructthe structure(S) and facilities detailed on the submittals reviewed by
the Building Division. ln consideration of the issuance of the Building Permit, lagree that land 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, construct¡on 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 submittals, if any, discovered after issuance; or (2l.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 inspectíons of the work by the Building
Dívision 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
d neer and/ or builderr,
OFFICIAL USE ONt o6
Special Conditions:f
Fees:IAMisc
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Plan. Check FeeL\, l]
Permit Fee:S25. oo Manu home Fee:
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BP No:
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OWTS'No:
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lABalance Due:
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Total Ëees:ıas- oÒ
Fees Paid
s 25.oo tflnrIOCC Group:ffi(),Const Tvoe:
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Setbacks:ûtA
*ú #4tnSigned Approval
BUILDING / PLANNING DIVISION ßvøØ/l-U