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Community Development Department
108 8th Street, Suite 401
..Glenwood SPrings, CO 81601
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Demolition-Comme rcial/Multi-Family
ReroofResidentiallex or TownhomeSFDu
or Multi-LevelManufactured Home
l-l Accessory Dwelling Unit (ADU)- MAXIMUM SIZE OF 1,OOO SQUARE FEET
INVOLVED PARTIES
Property Owner¡
Mailing .Address:
Email Address:
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Contractor
Mailing Address:
Email Address:
Architect:
Mailing Address:
Email Address:
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Mailing Address:
Email Address:
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Phone:
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Manufactured Home lnstaller:
Mailing Address:
Email Address:
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Job Address
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Assessor's Parcel Number:å3{þ3 t:$ aû* ll
# of Floors
Sub.
Owner's Valuation of Work: $
€4€-'Property Size (Sq. Ft. or Acres):
Sq. Ft. of Building:Height:
""f /Ã*Lot Block
AdditionRemodel/AlterationClass of Work:W"y
Garage:Attached Detached
Comm-unitySeptic
E lectric OtherPropaneNatural GasType of Heat:
Pernlit fl¡nptDriveway
Permit:
must be signed by the Owner of the property, described above,
not that of the Owner, a separate letter of authority, signed by
the Owner, must be provided with thís Application.
Legal Access. 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. Mult¡ple 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.
Authoritv. This application for a Building Permit
or an authorized agent. lf the signature below is
I hereby certify that I have read this Application and that the
understand that the Building Division accepts the Application
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 Garfield County Building
Code,OWTsregulationsandapplicablelanduseregulations(CountyRegulation(s)). lacknowledgethatthe
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) orany
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 Appl¡cation, 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
neer an or builderdre
information contained above is true and correct. I
, along with the plans and specifications and other
I hereby acknowledge that I have read and u nderstand the Notice and Certification above, as well as, have
provided the required which is and accurate to the best of knowledge.
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Property Owner Print and Sign
OFFICIAL USE ONTY
Special Conditions;
Manu. Home Fee:6òPermit Fee:Ltlo.55Check.con
2
No:Balance Due BP No:
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Fees Paid:\go,t{l
Fees:5\Total
ZonlConst. TypeOCC Group:t-,Setbacks:
ø 4t'rSBUILDING / PLANNING DIVISION
Signed Approval Date