HomeMy WebLinkAboutApplicationGarfield County
Community Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81601
(9701945-8212
www.Rarfi eld-countv.com
BUITDING PERMIT
APPLICATION
ryPE OF CONSTRUCTION
Commercial/Multi-Family Demolition
Manufactured Home or Tiny Home (Single or Multi-Level)
Residential (SF, Duplex or Townhome)T Reroof
Accessory Dwelling Unit (ADU) - MAXIMUM SIZE OF 1,200 SqUARE FEET
INVOTVED PARTIES
Property Owner:
Mailing Address:
/liv a Phone 1o 6s 6
(L../i Y tt1 d/
Email Address
Contractor:Phone:
Mailing Address:
Email Address:
Architect:Phone ()
Mailing Address:
Email Address:
Engineer Phone:
Mailing Address:
Email Address:
Manufactured Home lnstaller:Phone: (_)
Mailing Address:
Email Address:
PROJECT DETAItS
Describe Work:
Job Address 7-xr\ f)clV'tec-, C ,'. r Cnrp\
Assessor's Parcel Number
Sub.Lot Block
Owner's Valuation of Work: S Property Size (Sq. Ft. or Acres):
Sq. Ft. of Building Height:# of Floors:
€lass of Work New Remodel/Alteration Addition
Garage:Attached Detached
PROJECT DETAITS CONTINUED
]WTSSeptic:
Type of Heat:Natural Gas Electric
Driveway
Perrlil:
Authoritv. ThisapplicationforaBuildingPermitmustbesignedbytheOwneroftheproperty,describedabove,
orarrautlrorizedagerrt. lfthesignaturebelowisnotthatoltheOwner,aseparateletterofauthority,sigrredby
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.
OlherPcnnits. MultipleseparirLeperrrriLsrrriryberequired: (1) StaLeElecLricirl Perrrri[,(2) CuurrLyOWTSPerrrriL,
(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 L80 days
of the date of issuance and if work is suspended or abandoned for a period of 180 days after commencement.
Community
Propane Other
Exempt Permit #:
CERTIFICATION
NOTICE
lherebycertifythatlhavereadthisApplicationandthattheinformationcontainedaboveistrueandcorrect. 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 willcomply 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)). All County development requiring a permit, except for
residential uses, are subject 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 herphv srant narmicqinn tn the Rr rildino f'!ivicinn f^ antar iha nr^narfv docrriharJ ahnrrp f n incnc.t the rrrnrk 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 inspections of the work bythe Building Division do not constitute an
acceptanceof responsibilityorliabilitybytheCountyoferrors,omissions,ordiscrepancies. AstheOwner, 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 Notice and Certification above, as well as, have
provided the red information which is correct and accurate to the best of my knowledge.
IVCI t//
P Print and Sign Date
(n - \Z\-5q
Special Conditions:
Adjusted Valuation:Plan Check Fee:de-Permit Fee:\OO.Manu. Home Fee:Misc. Feesl
6tuTotal Fees:
\ a.l,&Fees Paid:
1(P
Balance Due:&-BP No:
?.nF-?AE\
OWTS No:
Setbacks:OCC Group:^<-{/(*ry'ffh '$tiIt
lo-tQ&BUILDING / PLANNING DIVISION
Signed Approval Date