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Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(970194s-82L2
www.garf¡eld-countv.com
Garfuld County
BUILDING PERMIT
APPLICATION @
Manufactured Home (single or Multi-Level)
ReroofResidential (SF, Duplex or Town home)
Accesso Dwell Unit DU) - MÆ(IMUM SIZE OF 1,000 SqUARE FEET
TYPE OF CONSTßUCÍION
Commercia
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u Demolition
INVOTVED PARTIES
Property Owner:
Mailing Address:
Email Address:cf s
Manufactured Home lnstaller:
PRO¡ECrDgÍAl[s
Describe Work:s aø clct
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Job Address
Assessor's Parcel Number:
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Owner'E Valuation of Work¡s '?r. çc,ó
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Phone:
Phone:
Mailing Address:
Email Address:
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Property Size (Sq" Ft. or Ares):(s,8?
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Contractor:
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Phone
Mailing Add f'flu
Phone:
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Architect:
Mailing Address
Email Address:
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Phone:
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Engineer:
Mailing Address
Email Address:
RemodeUAlteration r,lnaoitionNewClass of Work:
EdetachedAttachedGarage:
Sq. Ft. of Building:Height:# of Floors: ?
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Prooane. f.{ /^ElectricType of Heat:Natural Gas
Driveway
Permlt:
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PROJECT DTTA|$CONüNUED
Septic:F$/À Cornrnunity
Other
Permit #:
NOTICE
Authoritv. This application for a Building Perrnit must be signed by the Owner of the propertr¡, describecl above,
or an authorized agent. lfthe signature below is notthat ofthe Owner, a separate letter ofauthority, signed by
the Owner, must be provided with this Application.
legal Access. A Building Permit cannot be issued without proof of legal and adeguate access to the property for
purposes of inspections by the Building Division.
Other Perm¡ts. Multiple separate permits may be required: (1) State Electrical Permit, (2) County OWTS Permit,
i3i another perrnit required for use on the property identified above, e.g. State or County Highwayl Rsad 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 comrnencement.
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
clata sr¡bmitted by me or on my behalf {submittals}, based upon my certification as to accl¡racy. Assttming
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 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 Perrnit does not prevent the Euilding 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 const¡tute 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
d ccr or buiidar
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided which is corect and accurate to the best of my knowledge.
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Owner Print and Sign Date
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Special Conditions:
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31 .2tPlan Check Fee:
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Permit Fee:Manu,
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Totl Fees;
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Fees Paid:
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Const. Type:
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Zoning:
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Setbacks OC€ Group:r.t.(.
BUTLD|NG / PLANNING DlVlSlON :
Signed Approval
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Date
Gørfield County
BUILD,NG ÐEPARTMENî
1o8 E¡ghth Street, Suite 401, Glenwood Springs, Ca 8160j
Tel: (97a) s-8212
PLAN REVI EW CHECKLIST
Permit No: 8LÆ -O9-22-V83
Building lssues Pla n ning/Zoning lssues
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Engíneered Foundation
Driveway Permit
Surveyed Site Plan
Septic Permit and Setbacks
Property Line Setbacks
30 ft. Stream Setbacks
Flood Plaín
Building Height
Zoning Sign-Off
Road lmpact Fees
Grade/ Topography 40%
Planning lssues
Subdivision Plat
Grade/ Topography 30%
Attach Residential Plan Review Listçr+J7..f,1
Subdivision Plat Notes
Fire Department Review
Valuation Determination/ Fees
// Red Line Plan s/ Stampsl Sticker
Anach conditions PR/^/f
Application Signed
Plan Reviewer to Sign Application
NA 40# Snowload Letter - Manu. Homes
Soils Report
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Description & Summarv:
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244s.{ shm.1e x $2{= 7 ar¿
8og s.f. carfortx ftg= 454
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