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Communlty Deuelopment Department
tog 8û street, Sulte 401
Glenwood Springs, cO Er601
{9701 94s-8212
www.r¡rñeld.oottnty.roûr
Garfield Coanty
BUITDING PERMIT
APPLICATION
red Home or
Reroof
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Residential (SF, Duplex or Townhome) I
Dwelli Unit slzE oF FEET
EmailAddress; ,,OÉt$A-Ç44r,,úÊ{. - . .,, , .--.*," .,,,,,. , ,,, .,.* , ,,,
Phons:rn1ro t lffi -rll IProperty Owner:
Malllng Addresr:
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MailingAddress: ael -- øoÞ ça.J,¡t/reo Lø V\ttldtt4J-Érç4. è,,1bþç - ,..
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Ëmail Address:
Contractor:
Englneer: . , . . ,,.,.-Phone;
MalllngAddre$:... , - , .-.. .- , ,, ,
Manufactured Home lnstaller:
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Phone:
EqallAddress:
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¿{s,s a Aþtnms, &t-Email Address:
MailintAddtess:
Archltect:
sub. ,- Lot-Block-
owne/sValuationofWork;inotrI.t.-.PropertySlre(5q.Ft.orAcres)l-'
Sq. Ft. of Bulldlng:- l{el8hü- f of Floors:
Describe
I ao\oAssessol¡s Parcel Number:
Job Address:
RemodellAlteration AdditionXl¡vew fu@.a¡"rr o¡ 1¡lork;
DetachedGarage:
PñOJËSI D€TA¡U¡ COH?II*UËD
Septic:
lype çfHeat:Natural Gas
munity
Propane f lcctrit
Permìt #:
Other
Driveway
Permit:f-lËxempt
ffiü* Th¡s appticarion for a Building Permit mùst be signed by the ownàr of the property, de"rcribed above,
or ãn authorized agent. lf the signature below ¡s not that of the Owner, a separäte letter of author¡ty, signed by
the Owner, must be provided with this Application'
Leßal Access. A Building Permit cannot be issued without proof of legal and adequate access- to the property for
purposes of inspections by the Buildíng Division.
Other permits. Multiple separate perm¡ts may be required: {1} State Electrical Permit, (2) County OWTS Permit,
þ) another permit required for use on the property identifíed above, e.g. State or County Highway/ Road Access
or a stäte Wastewater D¡scherge Pert.TliT.
Vold perrnit. A Building perm¡ibecomes 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.
çERTFICAITOÍI '
I hereby certify that I have read this Application and that the information contained above is true and correct. I
understand that the Buildíng Division accepts the Application, along with the plans and specìfications and other
data submitted by me or on my behalf (submittals), based upon my certifìcation as to accurecy. Assuming
completeness of the submittals and approval of this Application, a Building Perm¡t will be issued Erant¡ng
permíssion 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 Build¡ng Permit, I agree that I and my agents will
comp¡y with provisions of any federal, state or local law regulating the work and the Garfield County Building
Code, OWTS regulðtions and applicable land use iegulations (County Regulation{s)). I acknowledge that the
Buìlding permit may be suspended or revoked, upon notice from the County, if lhe location, construction or use
of the structure(s) and facility(ies), described above, are not ¡n compliance with County Regulation(s) or any
other applicable law.
I hereby grant permission to the Building Divis¡on to enter the ploperty, described above, to inspect the work. I
funher acknowledge rhat the issuance of the Euild¡ng Permit does not prevent the Building Official from: {r)
requiríng the correction of errors in the submittals, if any, discovered after Ìssuance; 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 th¡s Appl¡cation, including submittals, and inspections of the work by the Building
Divisìon do not constitute an acceptance of responsibility or liability by the County of errors, om¡ss¡ons or
discrepancies. As the Owner, I acknowledge that responsibility for compliance with federal, state and local laws
and Cbunty Regulations rest wíth me and my authorized aEents, including without limitation my architect
dcrighe r, engineer a¡'rd/ or buil(ç¡
I hereby acknowledge that I have read and understand the Not¡ce and Certiflcation above, as well as, have
provided the required information which is correct and accurate to the best of my knowledge,
Property Print and Sign A¿F$_Date
ornîl¡rËronl
Special Conditions:
Misc. Fees::äl:2K Manu, Home Fee:
¡r/r
Plan Chêck Fee:ì2o8. t!Adiusted Valuation:1Ð.w
BP No:
BLCO - 6?5't
QIIITåITg:x/rBalance Due:
121,2{
Fees Paid;
208.8 I
Total Fees:
4,7A,@Ç
Const. Type:
--J È(.Zoningr
ResouÈc e LAÀlÞ
OCC Group:tÊcSetbacks¡
/+-.",,EUITDING / PTANNING DIVISION :
DateSigned