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Community Department
RECENED
:UU t 3 2019
log 8th Suite 401
Glenwood co 81601
(e70)
BUILDING PERMIT
APPLICATION
GørfuId County
Commercial/Multi-Family \Demolition
Home eor
RefoofResidential (SF, Duplex or Townho\e)
UM SIZE OF SQUARE FEETDwellUnit
r??Ot a48' -
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Mailing Address:
Email Address:
Property
Contractor:
Mailing Address:
Email Address:
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Phone
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Mailing Address:
Email Address:
Architect:
Phone:Engineer:
Mailing Address
Email
Manufactured
Email Add
Mailing
lnstaller:,!/e Phone: (_)
Describe Workr
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PropertySize (Sq. Ft. orOwner's Valuation of Work:
fofsq. Ft. of Building: f//î,îÔ Height:
Sub.(r'Q Block-
Assessor's Parcel Number:
Job Address:
VRemodel/Alteration ÁflditionClass of Work:New
Garage Attached Detached
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PROJECf DETAITS CONTINUED
Community
ral Gas Propane
Driveway
Permit:
Exempt
NOTICE
Authoritv. This application for a Buil ding Permit must be signed by the Owner of the property, described above,or an authorized agent. lf the signature b elow is not that of the Owner,a separate letter of authority, signed bythe Owner, must be provided with this Ap plication
authorized is not commenced within 1g0 days
a period of 180 days after commencement.
CERTIF¡CATION
I hereby certify that I have read this Application and that the info rmation contained above is true and correct. Iunderstand that the Buil ding Division accepts the Application,along with the plans and specifications and otherdata submitted by me or on my behalf (submittals), based upon my certification as to accuracy. Assumi ngcompleteness of the submittals and approval of this Application, a Building permit will be issued grantingpermission to me, as Owner, to construct the str ucture(s) and facilities detailed on the submitta ls reviewed bythe Building Division. ln consideration of the issuance of the Building permit, I agree that I and my agents w¡llcomply with provisions of any federal, state or local law regulating the work and the Garfield County BuildingCode, OWTS regulations and applicable land use regulations (County Regulation (s)). I acknowledge thar theBuilding Permit may be suspended or revo ked,upon notice from the County, if the location , construct¡on or useof the structure(s) and facility(ies), descri bed above, are not in compliance w¡th County Regulation(s) or anyother applicable law
I hereby grant permission to the Buil ding Division to enter the property, described a bove, to inspect the work. Ifurther 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) stoppingconstruct¡on or use ofthe structure(s) o r facility(ies) if such is in violation of County Regulation(s) or any otherapplicable law. Review of this Applicati on, including submittals, and inspectio ns of the work by the BuildingDivision do not constitute an acceptan ce of responsibility or liability by the County of errors, omissions ordiscrepancies. As the Owner, I acknowledge that responsibility for compliance with federal, state and local lawsand County Regulations rest with me and my authorized agents,including without limitation my architect
a or builder
I hereby that I and understand the Notice and Certification above, as well as, haveieluiredis correct and accurate to the best of my knowledge.
Permit #:
legal Access' ABuildingPermitcannotbeissuedwithoutproofof legar andadequateaccesstothepropertyforpurposes of inspections by the Building Division.
other Permits' Mult¡ple separate permits may be required: (1) state Electrical permit, (2) county owrs permit,(3) another permit required for use on the property identified above, e.g. state or county Highway/ Road Accessor a State Wastewater Discharge permit.
Void Permit. A Building permit becomes null and void if the work
of the date of issuance and if work is suspended or abandoned for
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1PropertyPr¡nt and S¡gn
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Septic:
Type of Heat:
Other
Adjusted Valuation Plan Check Fee:Permit Fee Manu. Home Fee¡Misc. Fees:
OFFICIAI USE ONIY
Special Conditions
Total Feesr Balance Due:BP No:
Mv-5got owrsNo: nla,
Setbacks:OCC Groupr Const. Type:
BUItDING / PIANNtNG DtvtsloN
Zoning:Puu
DateApprova
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