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Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
l97Ûls4s-82t2
www.Farfield-countv.com
Garfield County
BUILDING PERMIT
APPLICATION
-t
E OF CONSTBUCTTqN
com màrcia lf v ulti-ra mily
Manufactured Home
Residential Du lex or Townhome)
SqUARE FEET
T Reroof
INVOLVED PARTIES
Property Owner:
Mailing Address:
Email Address:
Contractor:
Mailing Address:
Email Address:
Phone:
8?2 b
Phone: ( )Architect;
Engineer:
Mailing Address:
Email Address:
Phone:
Mailing Address
Manufactured Home lnstaller:
Email Address:
Email Address:
Mailing Address
Phone:
PROJECT DETAILS
Describe Work:
Job Address:
Assessor's Parcel Number
Sub
Ownerls Valuation of Work
Sq. Ft. of Building:
Class of Work:New
5
0f,
Lot Biock
Property Size (Sq. Ft. or Acres):
f of Floors
dition
Height:
Garage:Attached
6
Remodel/Alter
Detached
Septic:
PROJECT DETAILS CONTINUED
Type of Heat Natural Gas Propane
Community
E I ectri c
Permit #:Driveway
Permit:
NOTTCE
mpt
Authoritv. ThisapplicationforaBuildingPermitnrustbesignecJl-ryllreOwneroftheproperty,clescrihedabove,
oranauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedby
the Owner, must be provided with this Application.
Legal Access. A tsuilding 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.
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 specifications and other
data submitted by me or on my behalf (submittals), based upon rny cerlificaLion as to accuracy. Assuming
completeness of the submittals and approval of thisApplication, a Building Permitwill be issued granting
permiss¡on to me, as Owner, to construct the structure(s) and facilities detailed on the submittals reviewed by
the Building Division. ln consideration of the issuar¡ce ol'the Building Permit, lagree that land 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: (L)
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¡ttals, and inspections of the work bythe Building
Division do not constitute an acceptance of responsibility or liability by the County of errors, om¡ssions or
discrepancies. As the Owner, I acknowledge that responsibility for conrpliarrce witlr federal, state arrd local laws
and County Regulations rest with me and my authorized agents, including without limitation my architect
designer, engineer and/ 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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Prope er Print and Sign Date
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Other
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Special Conditions:
Adjusted Valuation:Plan Check Fee:Permlt Fee:
* too.aa
Manu. Home Fee
r.¡/A
Misc. Fees
Total Fees:Fees Paidli loô. ôà
Balance Due:
+-d
,BP Nor
Poor -1{?5 OWTS Nor¡ll¡
Setbacks OCC Group:Const. Type:
,. È,c.
Zoning:
P. u,D.
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Date
BUILDTNG / PTANNTNG DTVTSTON :