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Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
ltg7ol945-82t2
www.ga rfi eld-countv.com
Gørfield County
BUILDING PERMIT
APPLICATION
TYPE OF CONSTRUCTION
Demolitionulti-FamiCom
Manufactured Home or Multi-Level)
Reroofor TownhomentialDu
Accessory Dwelli DU) - MAXIMUM SIZE OF SQUARE FEETUnit
INVOTVED PARTIES
Phone: ?z'pt É/? Va7ea
Email Address:
Property Owner:
Mailing Address:
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tÀIL
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Phone:,47o,371-ß1tContractor:
Mailing Address:
Email Address:
Architect:
Mailing Address:
Email Address:
Phone: 671 t î63 ^ 3123
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Mailing Address:
Email Address:
Engineer:
PhoneManufactured Home lnstaller
Mailing Address
Email Address:
PROJECÍ DETAILS
Sub. lot
-
Block
Describe Work:<-,l-¿íD
3
03
Height:'/"-"tç /nçn
ß*;l)
Property Size (Sq. Ft. or Acres):
f of Floors:
Owner's Valuation of Work: $
Sq. Ft. of Building
Assessor's Parcel Number
Job Address:
Additionl/AlterationReEWClass of Work:
DetachedAttachedGarage:
l
Septic:
Type of Heat:Othe r
PROJECf DETAITS CONTINUED
Natural Gas Propane^f Þl
Community
E lcctric
Driveway
Permit:
I--
FR"*n,Permit #:
NOTICE
ication for a Building Permit must be signed by the Owner of the 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 Perm¡t 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.
AuthoriW. This appl
CERTIFICATION
ave 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 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. 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 Garfielcl Cor¡nty Builcling
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: (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 ìnspections 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 certify that I h
I hereby acknowledge that I have and understand the Notice and Certification above, as well as, have
provided the req ich is correct and accurate to the best of my knowledge.
6 2-.")-
Property Owner Sign Date
oFFrcrAtusEoNty PAIÞ, i 324r,95 e.e./zozziFÞ
Special Cond¡t¡onsi ØrlbtnaA/6
Adiusted Valuation:
,4\NOod Plan Check Fee:
þ.a2L.63
Permit Fee:$îoz,75 Manu. Home Fee:xla Misc. Fees:
^//4TotalFees:
þ g2g .8e
Fees Paid:
* 32C.53
Balance Due: -þtu2.ú BP No:
ftRe-É?5 OWTS Ño:
r.l/¿-setbacyø
OCC Group:
¡. ß. (..Const. Type:
l.ß.c,
Zoning:
RIJRAL
fliil'9-,?Z
Date
BUTLDTNG / PTANNtNG DtVtStON :
Signed Approval
I
Gørfield Coanf¡
BUILDING DEPARTMENT
108 Eighth Street, Su¡te 407, Glenwood Springs, CO 87607
Tel: (970) 945-8212
PLAN REVIEW CHECK LIST
BtRs-Ò7-z?7áAéPenmit No:
Building lssues Pla nning/Zon ing lssues Rur?,+L
dhþiû
./
/ soits Repgrt ,20Øpqf /o?Ð 2a/erÇure4
tloas,f. wund|h'oîe¿
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Engineered Foundation
Driveway Permit
Surveyed Site Plan
4tßoaprcpØrLl
Septic Permit'a nd letbacks /
Grade/ Topography 30%
Attach Residential Plan Review List
Subdivision Plat Notes
Fire Department Review
Valuation Determination/ Fees
Red Line Plans/ Stamps/ Sticker
Attach conditions fuin{_
Application Signed
Plan Reviewer to Sign APPlication
Parcel/Schedule No.
40# Snowload Letter - Manu. Homes
Property Line Setbacks
30 ft. Stream Setbacks
Flood Plain
Building Height
Zoning Sign-Off
Road lmpact Fees
Grade/ Topography 40%
Planning lssues
Subdivision Plat
N4
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