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Communlty Development Department
108 8th Street, Sulte 401
Glenwood Sprlngs, CO 81601
(9701 94s-8212
www.sarfleld-counw.com
Accesso Dwelli Unlt ADU - MAXTMUM S|ZE OF 1,000 SqUARE F€ET
Property owner: ?-** + ?vxls¿¡,? tnìTtt Phone: Û'lo t ,r.r '
"UrUMalllng Address bU t'le*DaW LlJ &w .ç er. Sl bal
Emsll Addres¡:Roa¿zT s?ltfn @. Copt*tc ,u*
contracror: U ØoT tf C7tÃT9.J,CTtît6 - CHFIS &# ,nonu,11?o .¡ ltZ-' t?tt
Malllng Addre¡¡:lîaL ÅtÐrzL Aw . ùtß. co.Ltba I
Emall Address:filgts Q u ôorr7 (¡itflft-Ac//t ú6..C-^Pt
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BUILDING PERMIT
APPLICATION
ûemolltlon
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Residentlal D lex or Townhome
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Manufactured Home
Reroof
Archlt€ct: .- Phone:
Malllng Addres¡;
Emall Address:
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Englneer:ODùo FNAaI ¿:¿¡zt! 6 Phone: { )
Malllng Addre¡s:
Molllng Addressr
EmallAddress:,,-... .-- ,, -.,, .., ..,--...-..-., --,, ,,,., - ---- .-..
Manufactured Home tn¡tallen
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Descrlbe Work:Ngt^l B*ct¿M*
Cluss of Work:
Job Addre¡sr bU tlel\ow t,u CsN5,Q , ll(rol
Asse¡¡or's Parcel Number:2916otzobot5
sut. þøsrä¡rfl#f-Jl .,#:¡ *.. .." rot ..19. -- Block-*
owne/sValuatlonofWorkl$-PropertySl:e(Sq.Ft,orAcres}:|,zl:1Ac|,Es
Sq. Ft. of Bulldlng:24 55 Helghtr I of Floor¡: I ..,...
Addltlon
Garage:Attached
Remodel/Alteratlon
0et¡ched
I PROJECT DËTA]tS CONIINUED
Septlc:
¡ltr"r¡l G¡s
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Comrnunity
Ë Iee lrir:
Permit ll:
Other: TYpe of Heat:Propane
Drlveway
Permlt;
îorrcÉ
xempt
Authojltv. This application lnr a Euilding pcrm¡t must be :iigned by the Ownnr of the propr:rty, dcle ribecl .:br:ve,
or an âuthorized agent. lf the signature below is nc¡t that of the Owner, ð separðte letter of ðuthority, signed by
the Owner, must be provlded with this Application.
!egA! Access. A Building Permit cannot be issuecl without proof of legal and adequate access tÕ the property for
purposes of inspectlons by the Building Division,
Other Permlts. Multiple separate permits may be required: (1) State Electrical Permit, (2) County ÕWIS Permit,
(3) another permit reguired for use on tl'ìe propertV identified above, e,g, State or County SiShwaV/ Road Access
o¡ ¡ State Wastewater Discharge Permit.
Vold Permlt. 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 dayr after commencement.
CERTIFICATION
I hereby certify ihat ì have read this Application and that the information contained above is true and correct' I
understand tlrat the Building Division accepts the Applicätíon, along w¡th the plans and specifications 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 Applicatlon, a Building Permit will be issued granting
permission to me, as Owner, to construct the structure(s) and facilities detailed on the submíttals reviewed by
the Building Division. ln consideration of the issuance of the Building Permit, I agree that I and my alents will
comply with provisions of any federal, state or loc¡l law regulating the work and the Garfíeld County Building
Code, OWTS regulations and applicable land use regulat¡ons (County Regulation(s)). I acknowledge that the
Building Permit may be suspended or revoked, upon notice from the County, if the location, constructíon 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 properly, described above, to inspect the work. I
further acknowledge that the issuance of the Build¡ng Permit does not prevent the Build¡ng Official from: (1)
requiring the correction of errors in the submittals, if any, discovered after issuance; or {2) stopping
construct¡on or use of the structure{s) or facility(ies) if such is ín 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
designer, engineer and/ or builder.
I hereby acknowledge that I have read and understand the Notlce and Certlfication above, as well as, have
ed the req ulred lnformatlon whl and accurate to the best owledge
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Property and Slgn Date
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oFFICIALUSEoNtY P*tp $,trl C,C, A /*o 2¿
Speclal Condltlons:
Adlusted Valuatlon:€2,æ.æ '"wry:Y;1"','i'å1.'2a Manu. Home Fee:x/*''"ñ7+
'"Ytz,aø Fees Pald: -
+ g?. 6t
Balance Due:
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BUILDING / PTANNING DIVISION I
Slgned Approval
Framing plans for each floor level and roof. All beams, columns, joists, rafters and trusses
specified. Pre-manufactured structures require the engineers stamp, signature and date,
Framing /connection details, braced wall lines, shear wall schedule, location and hold downs.
NOTE: lf any required information is missing, delays in issuing the permit are to be expected, lf
determined by the Building Official that additional information is neces$ary to review the application
and/or plans ior comptiance, 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 witho,ut a
CO wilf be considered an illegal occupancy and may be grounds for vacating the premises, (Final/CO
inspection requirements will be attached to your approved fìeld set of plans,)
I hereby acknowledge I have read, understand and wlll abide by the requlrements of this
checklist.
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Prope Print and Sign Ðate
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