HomeMy WebLinkAboutApplicationGørfield County
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Community Development Department
1OB 8th Street, Suite 401
Glenwood Springs, CO 81601
(e7ol e4s-8212
www.Fa rf ¡ el d-cou ntv.com
OF CONSTRUCTION
Commercial/Multi-tamily
Manufactu red Home (Single or Multi-Level)
Residential
Demolition
Reroof
SQUARE FEET
BUILDING PERMIT
APPLICATION
INVOTVED PART¡ES
Property Owner:
Mailing Address:
Email Address:
Architect
Phone: t 4fu ¡7N-q7
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Phone¡ ( )
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Mailing Address:
Email Address:
Engíneer Phone: { )
Mailing Address
Email Address:
Manufactured Home lnstaller Phone:
Mailing Address
Email Address:
PROJECT DETAITS
Describe Work:
Job Address:
Assessor's Parcel Number
Sub
Owner's Valuation of Work: S
5q. Ft. of Buílding:
Class of Work New
oè
Lot Block
Y
\l,
Property Size (Sq. Ft. or Acres):
# of FloorsHeight:
dition
Contractor
Mailing Address:
Email Address
Garage Attached
Remodel/Alteration
Detached
PROJECT DETAITS CONTINUED
Septic:
Type of Heat:Natural Gas I
I
Exempt
Propane
Community
Electric
Permit tl:
I
1
I
üther
Driveway
Permlt:
NOTICE
Authoritv. This application for a Building Permit must be signed bythe Owner of the property, described above,
oranauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedby
the Owner, must be provided with this Application.
LeeAlAqess. 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. M ultiple 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.
VoidPermit. ABuildingPermitbecomesnull andvoidiftheworkauthorizedisnotcommencedwithinlS0days
of the date of issuance and if work is suspended or abandoned for a period of L80 days after commencement,
ì CERTIFICATION
I hereby certify that I have ràaà 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 or1 my behalf (submiLLals), 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. In consideration of the issuance of the Building Permit, Iagree 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 thc
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.
lherebygrantpermissiontotheBuildingDivisiontoentertheproperty,describedabove,toinspectthework. 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 ¡ssuance; 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 bythe County of errors, omissions or
discrepancies. As the Owner, I acknowledge that responsibility for compliance with federal, state and local laws
and County Regulations restwith me and myauthorized agents, includingwithout limitation myarchitect
designer, engineer and/ or builder.
I herebv 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.
Zç*Z^02-__.
Property Owner Print and Sign Date
oFFrcrAtUsEoNtY PA¡D llOO.co C.c. c$Þz/zoz-z éfq*
Special Conditions:
AdJusted Valuatlon:Plan Check Fee:Permit Fee:* loo.oo
Manu. Home Fee:
N/A
Misc. Fees:
Total Fees:Fees Paid:
{ loo.oô
Balance Duel4ø BP No:
ROof _ Tr{B l
OWTS No:
N/A
Setbacks:OCC 6roupl Const, Type:
t. R.c.
Zoning:
P. u. Þ.
oilnlzozz
Date
BU¡LDING / PLANNTNG D|V|SION