HomeMy WebLinkAboutApplicationGørfield County
BUILDING PERMIT
APPLICATIONRgofEIViEU DeveloPment DePa rtme
1O88th Street, Suite 401
',:;i , Glenwood SPrings, CO 81601
ß701945-82L2
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STRUCTIONcoNOFTYPE I Demolition
Commercial/Mu
or Multi-Level)Manufactured Ho me Si Reroofor TownhResidentialDu
Dwelli
FEETSQUAREOFUM1,000srzEMAXIMnUADU)it
tNvowED PARTIES
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(Phone: tQic>13fr-It'SQ
Email Address:
Property Owner:
Mailing Address:
Phone: (--)-Ftt5pr*-Contractor:
Mailing Address:
Email Address:
Phone:13o3 )B$q
Arch¡tect:L\XL Oúe\
Mailing Address:
Email Address:
$,^.Phone: e?o \3Ub-8Ucì ()
Engineer:
Mailing Address:
Email Address:
Manufactured Home lnstaller:Phone:
Email Address:
Mailing Address:
PROJ ECT DETAITS
Describe Work:
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Height:
Lot S frcrs
t L{r{
Owner's Valuation of Work: S l,Lt)
Job Address:
Sq. Ft. of Building:\.rz'Ç
Assessor's Parcel Number:
Property Size (Sq. Ft' or Acres):
¿>q k rof Floors:
Sub.
Block
-
AdditionRemodel/AlterationNewClass of Work:
DetachedttachedGaragel
Community
PROJECT DETAILS CONTINUED
Septic:
OtherElectricPropaneatural GasType of Heat:
Permit #:ExemptDriveway
Permit:
NOTICE
the Owner, must be provided with this Application'
Lesal 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 ,up"rrt" 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'
Voidpermit. ABuildingpermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinlS0days
of the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement'
of the property, described above,
rate letter of authoritY, signed bYAuthoritv. This application for a Building Perm
or an authorized agent. lf the signature below
¡t must be signed bY the Owner
is not that of the Owner, a sepa
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
CERTIFICATION
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I hereby acknowledge that I have and understand the Notice and Certification above, as well as, have
provided req is correct and accurate to the best of my knowledge
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Property Owner Print and Sign Date
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Special Conditions:
Misc. FeeslManu. Home Fee:Permit Fee:Plan Check FeeAdjusted Valuation:
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BP No:Balance Due:
#
Fees Paid
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Total Fees:
LZoning:
fLv
Const. Type:OCC GrouP:Setbacks:
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Dete
BUILDING / PLANNING DIVISION
