HomeMy WebLinkAboutApplicationi C -c;iiiiiii c;;;,ti, )
Community Development Department
108 8th Street, Suite lml
Glenwood SPrings, CO 81601
(e701 e4s-8212
@
wPE OF COIISTRUCTiOII
[] commerciallMulti-Family t:Demolition
[--l uanufactured Home or Tiny Home {single or Multi-Leve',
G] RerooflSZl Residential (SF, Duplex or Townhome)
fr n..*rrory Dwelling Unit (ADU) - MAXIMUM SIZE OF 1'200 SQUARE FEET
INVOTVED PARTIES
Phone: \-g3A
(**_+s
Property Owner:
Mailing Address:
Email Address:
Contractor:
Ma
'-{
t
u\orre &+i
Mailing Address:4
Email Address:
Architect:
LLC;'4/\(tj 45n 7
{15 z-L'\
Phone:
Phone: {
Address:
Phone:Englneer;
M ress
Manufactured
l Address:
Phone:
Address:
PROJECT DFTAITS
Describe
lob Address:5
Assessor's Parcel Number:
5ub
Owner'i Valuation
5q. Ft. of Building:
u7tij Height
class of work: [rtu* ffi*on"'/Alteration
6arage: Attached /
r-ot _l d Block -*-_
Property Size (5q. Ft. or Acres|: *}"*{-A.ft\*a
f of Floors: I -
Addition
Detached
of \Alork:
2
PROJECT DETAILS CONTINUED
Septic:
Type of Heat:
at
ftlowrs
fTlNaturalGas Propane
Community
hIectflc
Permit #:
Other
Driveway
Permit:
NOTICE
A[thgitv. This application for a Building Permit must be signed by the owner of the property, described above,
or an authorized agent' lf the signature beiow is not that of the Owner, a separate letter of authority, signed by
the Owner, must be provided with this 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. Multiple separate permits may be required: (1) State Electrical permit, (Z) County OWTS permit,
{3i another permit required for use on the property identified above, e.g. State or County Highwayl Road Access
or a State Wastewater Discharge Permit.
Void {ermit A Suilding Permit becomes null and void if the work authorized !s not commenced within 1g0 days
of the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
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 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 subnrittals reviewed by the Building Divislon. ln
consideration of the issuance of the Building Permit, I agree lhat I and my agents will comply with provisions of any
federal, state, or local law regulating the work and the 6arfield County Building Code, OWTS regulations and
applicable Iand use reguiations (County Regulation{s}}. All County development requiring a permit, except for
residentiai uses, are subjeet to Article 7 of the Land Use and Development Code. 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 lhe Building Permit does not prevent the Building Official from: (1) requiring
the correction of errors in the submittals, if any, dlscovered afler issuance; or (2) stopping construction or use of the
structure(s) or facility(ies) if such is in violation o{ County Regulation{s) or any other applicable law. Review of this
Application, ine luding 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 wiihout linritation my architect designer, engineer andl or builder.
I hereby acknowledge that I have read and understand the Notice and Certifieation above, as well as, have
required information which is correct and accurate to the best of my knowledge"
(sr
Property Owner Print and Sign Date
OFFICIAL USE ONIY I
Special Conditisns:
Adjusted Valuation Plan Check Fee:P;ffi""iro Manu. Home Fee:Misc, Fees:
Total Fees:
toC)oc)Fees Paid cc)lcn.Ealance Due:+-8P No:
mF-R1€4 OWTS No:
Setbacks OCC Group Const. Type:Zonine
[{
BUTLDTNG / pTANNTNG oltsa 0'-4:-A 4
Signed Approval Date