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Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
l970l94s-82L2
www. garfiel d-countv.com
INVOTVED PARTIES
Property Owner:3A¡'/luriL
Mailing Address:P,o Bot/ QçG 9,lt
Phone: ( q70l 3l q - t)/"vz -þ Qt-¡g -8221
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Garfield County
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BUILDING PERMIT
APPLICATION
D3WPE OF CONSTRUC͡ON
Com mercial/M u lti-Family Demolition
M Home (Single or Multi-Level
dential (SF Du or Townhom Reroof
Accessory Dwelling Unit (ADU)- MAXTMUM SIZE OF 1,000 SqUARE FEET
Phone:L,eContractor3
Mailing Address:
Email Address:
Mailing Address:
Email Address:
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Mailing Address:
Email Address:
Mailing Address:
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PRO¡ECT DETAITS
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Q. t'<rÃro É.ÞAssessor's Parcel Number:
Job Address:
Owner's Valuation
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Community
CERTIFICATION
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 specificat¡ons 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 structure(s) and facilities detailed on the submittals reviewed by
the Building Division. ln consideration of the issuance of the Building Permit, I agree that I 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 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 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 (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 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 me and my authorized agents, including without limitation my architect
e neer an or builder
I hereby acknowledge that I have read and understand the Notice and Certification above, as we ll as, have
provided the required information which is correct and accurate to the best of my knowledge.
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PROJECT DETAI
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OtherElectricNatural GasType of Heatl
AuthoriW, This application for a Building Permit must be signed by
or an authorized agent. lf the signature below is not that of the Owner, a separate letter of authority, signed by
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 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.
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 180 days after commencement.
NOTICE
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the Owner ofthe property, described above,
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Special Conditions:
Misc. Fees: - 'Rltrê.øìt=$t;Perm¡t Fee:6/,44n35 Manu. Home Fee:*/xAdiusted Valuation: ¡
+:iaf) 49l,qll-
Plan Check Fee:
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BP No:
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OWTS Ño: ¿
s€pr - g&q+iix¿:äTnTotal F6es:
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tt{Fees Paid
Const. Type:
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Zoning:
ÈURAL
OCC Group tÈc'*o2rÞ
b-2441BUILDING / PLANNING DIVISION :
Signed Approval
L%r-,
Date
Gørfield CounQ
BUILDING DEPARTMENT
108 Eighth Streel Suite 407, Glenwood Spr¡ngs, CO 81607
Tel: (970) 945-8212
PLAN REVI EW CH EC KLIST
Permit lrlo:BuRE-0b-21- 6Ø qz
Building lssues
Engineered Foundation
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Planning/Zoni lssues
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Property Line Setbacks
30 ft. Stream Setbacks
Flood Plain
Building Height
Zoning Sign-Off
Road lmpact Fees
Grade/ Topography 40%
Planning lssues
Subdivision Plat
Surveyed Site Plan
ftPf-þØteptic Permit and setbacks I/
L/Grade/ropography3o% þakffi)
Attach Residential Plan Review List vE5
/ tro¿rvision Plat Notes
Fire Department Review
Valuation Determ¡nation/ Fees
Red Line Plans/ StamPs/ Sticker
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Desçríption & 5umrylq¡y:
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Application Signed
Plan Reviewer to Sign APPlication
Parcel/schedule No.
40# Snowload Letter - Manu. Homes
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NOTE: lf any required information is missing, delays in issuing the permit are to be expected. lf
determined by the Building Official that additional information is necessary to review the application
and/or plans ior complianðe, the application may be placed on hold untilthe required information is
provided. Work may not proceed without the issuance of a permit.
The Building Division will collect a Plan Review fee at time of application submittal, The permit fee, as
well as any Road lmpact fees will be collected when the permit is issued.
The permit application must be signed by the owner or by person having written authority from the owner
to act as their representative.
Building cannot be occupied until a Certificate of Occupancy (CO) is issued. Using the building without a
CO wilfbe considered an illegal occupancy and may be grounds for vacating the premises. (Final/CO
inspection requirements will be attached to your approved field set of plans')
I hereby acknowledge I have read, understand and will abide by the requirements of this
checklist.
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Print and Sign DateP