HomeMy WebLinkAboutApplicationGørfield County
€ommunity Development Depãrtment
108 8í'Street, Suite 401
Glenwood Sprlngs, CO 81601
ls7ols4s-82t2
www.Êarfie ld-cou ntv.com
BUILDING PERMIT
APPLICATION
Commercia Iti-Fami Demolition
Manufactured Home (Single or Multi-Level)
Residential (SF, Duplex or Townhome)Reroof
A,ccessory Dwelling Unit {ADU} - MAXIMUM S|ZE OF 1,000 SQUARE FEET
hry.gTVED PARTIES
Email Address:
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Mailing Add ,"uï t'o\( lt)/ 4'? frf,rtt¡nw cct
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Property Owner:
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Phone:
Address: fþX t'Òt ¿/7 *fpø C" 8/¿/z-
Ð,Email Address:
C6ntrector:fl?o t329 c;6¿l 7
Mailing
ù ¿h;Phone: { )Architect:
Mailing Address:
Email Address:
u I ft û f*l r: Q *J ult phone: IEngineer:
Mailing Address:
Email Address:
Email Address:
¿/p, wt Property size (5q. Ft. or Acres); < ;- 4(ZûÉ-J
Describe Work:
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Job Address:
øt 3 I Block-
Phone:
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Height:Sq, Ft. of Buílding '7 - e*o
Assessor's Parcel Numbe r, 2l I ? 3 6toHoSt
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PRO]ECT DETAITS
#olFloots: *?-
9wner's Valuatisn of Work; $
Manufactured Home lnstaller:
Mailing Address;
Class of Work:New Remodel/Alteration lAddition
r4,;
tlJ
Garage:Detached
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PROJECT DETAITS.CONT¡NUED
Commun¡tyÍe¿)e - fflnseptic:
OtherElectricPropaneType of Heat:
Permit #:Driveway
Permit:
NOTICE
the Owner, must be provided with this Application-
Legal Access, A Building perm¡t cannot be issued without proof of legal and adequate access to the property for
purposes of inspections by the Build¡ng Division.
Other permits. Multiple i.prr.t" permits may be required: (1) State Electrical Permit, {2) County OWIS Permit,
1a¡*otn.r permit required for use on the property ident¡f¡ed above, e.g. State or CountY Highway/ Road Access
or a State Wastewater Discharge Permit.
Vold permit. A Building permit becomes null and voíd 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'
the described bove,ofbetheOwnerBuildirnustby propertyPermitaI nrç for ã signedngpplicationAuthoritv.
ofletter bytheofOwnersignedauthority,ãbelownotsat separateth¡f the ret.aor ãutn horized signatugen
data submitted by me or on my behalf (submittals), based upon my certification as to åccuracy- 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 Bu¡ld¡ng Permit, t agree that I and my agents will
comply with provisions of any federal, stete or local law regulating the work and the Garfield CcuntY 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 facilìty(ies), described above, are not in compliance with County Regulation(s) or any
other applicabte 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 ihe 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 subm¡ttâls, and inspections of the work by the Building
Divis¡on do not const¡tute an acceptance of responsibility or liability by the county of errors, omissions or
discrepancies. As the Owner, I acknowledge that respons¡bility for compliance with federal, state and local laws
and County Regulations rest with me and my euthorized ägents, including without l¡mitation mV architect
contained above is true and correct' I
the plans and specificat¡ons and other
thethat nform natiosandthatreadhavethihApplicationcertifyereby
al withDivisionthen,ongthethåtBuindiApplicationderstanddÞacceptsu
and/ or builderer
I hereby acknowledge that I have read an d understand the Notice an d Certification above, as well as, have
provided the required information which is correct and accurate to the best of my knowledge.
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' ¿ '¿¡tcYU 7¡¿ f Dat€Print and Sign
ONtY 1o(,c¿zs
Special Conditions: I É3t 6;Þ
Mísc. Fees:Manu. Home Fee:
¡t /*Permit Fee:Plan Check Fee:i2î.uAdjusted Valuation:
OWTS No:- *7r¡
Balance Duel
./
BP No:
Pø¡to ' c1*lFees Paid;i zS. o-oTotal Fees
$ es.er
ZoningtRtl¿¡t-Const. TYPe:OCC Group:Setbacks:
oE/ rc/z.ozt
DeteSigned
BUITD¡NG / PTANNING D¡VISION