HomeMy WebLinkAboutApplicationGarfield CountY BUILDING PERMIT
APPLICATIONCommunitY DeveloPment Department
108 8th Süeet, Su¡te 401
Glenwood SPrings, CO 81601
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www.garfield-countv'com
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Email Address:
Phone: (\:hP ) 3?f\- SB]-€
PropertY Owner:
Mailing Address:
Phone:
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Contractor:
Mailing Address:
Email Address:
Phone:rhArch¡tect:
Mailing Address:
Email Address;
Phone:
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âEngineer:
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Mailing Address:
Email Address:
Phone:
Email Address:
Manufactured Home lnstaller:
Mailing Address
PROJECf
ofwork: 5 ? Ø,,øo^¡-:.' o Ô Propertysize(Sq'
Describe Work:
# of Floors:Height:
Sq. Ft. of Building:
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Sub
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Lot I Block --I
Ft.orAcres): N UÇO
Owner's Valuation
Assessor's Parcel Number:
Job Address:\cu. <
AdditionRemodeUAlterationNewClass of Work:
Detached
AttachedGarage:
PROJECT DETAITS CONTINUED
CommunitySeptic:
OtherElectricPropaneNatural GasType of Heat:
Permit #:ptDriveway
Permit:
NOTICE
Authoritv.This application for a Building Permit must be signed by the Owner ofthe property, described above,
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'
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 ,"prrrt" permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
(S)
"noth"r.
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 permii 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'
CERTIFICATION
I hereby certifY that I have read this Application and that the information contained above is true and correct' I
understand that the Buildi ng 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
comp leteness of the submittals and approval of this Application , a Building Permit will be issued granting
perm ission to me, as Owner, to construct the structure(s) and facil ities 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 Regu lation(s)). I acknowledge that the
Building Permit maY be suspended or revoked, upon notice from the County,if the locat¡on, 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 ¡nspect the work' I
further acknowledge that the issuance of the Build¡ng 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 ineer an or builder
I hereby acknowledge that I have read and understand the Notice and 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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Property Owner Print and Sign Date
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Special Conditions:
Misc. Fees:
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A
Manu. Home FeelPerm¡t Fee:* zl,æPlan Check Fee:Adiusted Valuation:
OWTS No:
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BP No:
Deuo '1A3'7
Balance Due:Fees Paid:izu aêTotal Fees:
f 21,æ
Zoning:
É.ufL^l-Const. TypeOCC GrouP:Setbacks:
BUILDING / PLANNING DIVISION
ed Approval
04"fu2
Date