HomeMy WebLinkAboutApplication. Garfield County
Community Development Department
108 8`" Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.gartield-county.com
BUILDING PERMIT
APPLICATION
TYPE OF CONSTRUCTION
0 Commercial/Multi-Family
Q Manufactured Home (Single or Multi-level)
Q Residential (SF, Duplex or Townhome)
Q Accessory Dwelling Unit (ADU) - MAXIMUM SIZE OF 1,000 SQUARE FEET
=Demolition
Q Reroof
INVOLVED PARTIES
Property Owner: 0 Hadi 10 C _ a \' � Wily o m S Phone: ( of ) 5 y .1 5 -47'1
Mailing Address: 365 5kosttcnQ nett+. CO. 8tG5,a
Email Addresss:�f'AaA.�'C'�t(Ye \ 9Cn & t3rnAlt -rom
Contractor: L.\`r` _XarA{lasG.Jr ers:'Qoe%rj Phone: ( (770) Ct aaqa
30 (5 tV�o ot.)rn Dr. co ra,A TUMG1"t6/1
Mailing Address:
Email Address: CO'r. M SearALCSS g tTT4e-YSenO \ - CD rek
Architect: Phone: ( )
Mailing Address:
Email Address:
Engineer: Phone:( )
Mailing Address:
Email Address:
Manufactured Home installer: Phone: ( )
Mailing Address:
Email Address:
PROJECT DETAILS
Describe Work: R& RbOc
Job Address: 3t,5 f 1r eThlAtNT, 5° 14- en- 9(L s a
Assessor's Parcel Number:
Sub. Lot Block
Owner's Valuation of Work: $ Property Size (Sq. Ft. or Acres):
Sq. Ft. of Building: Height: # of Floors:
Class of Work: New ❑Remodel/Alteration ❑Addition
Garage: Attached Detached
PROJECT DETAILSCONTINUED
Septic: J v I5 ❑ Community
Type of Heat: ENatural Gas Propane LiElectric❑ Other
Driveway ❑Exempt Permit 11:
Permit:
NOTICE
Authority. This application fora Building Permit must be signed by the Owner of the property, described above.
or an authorized agent, If the signature below is not that of the Owner, a separate letter of authority, signed by
the Owner, must be provided with this Application.
Letal 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
Qthcr Permits., 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
Vold Pcrmlt, A Building Permit becomes null and void if the work authonred 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 +s 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 structures) and facilities detailed on the submittals reviewed by
the Building Division. In consideration of the issuance of the Building Permit, I agree that 1 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 Reguiaaon(s)) f acknowledge that the
Building Permit may be suspended or revoked, upun 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, describec above, to inspect the work I
further acknowledge that the issuance of the Budding Permit does not prevent the Building Official from 11)
requiring the correction of errors in the submittals, if any, discovered after issuance, or (2) stopping
construction or use of the structure(s) or faciliiy(ies) if sucn 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 rio and my authorized agents, including withuut limitation my architect
designer, engineer and/ or builder
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
rov'ded t • required information which is correct and accurate to the best of my knowledge.
Date
,o
Special Conditions:
Adjusted Valuation:
Total Fees:
$100.00
Setbacks:
Plan Check Fee
Fees Paid
$100.00
Permit Fee:
$100.00
Balance Due:
$0.00
OCC Group:
IRC
BUILDING / PLANNING DIVISION :
Pp. ,L `pa_ oo, Ca, Sys
Manu, Home Fee
ELKQ:
ROOF -08-20-6429
Const. Type: IRC
Misc. Fees
OWTS No
Zoning: RURAL
7/6-71970