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Community Development Department
108 8th Street, Suite 401
Glenwood SPrings, CO 81501
(9701s4s-82L2
www.garf ield cou ntvco. gov
Garfield County
BUILDING PERMIT
APPLICATION
TYPE OF CONSTRUCTION
DemolitionCommercial/Multi-Famil
Manufactured Home or e or Multi-Level)Home
I ReroofDuor TownResidential
SQUARE FEET- MAXIMUM SIZE OFDwelliUnit
INVOLVED PARTIES
Email Address:
PhoneProperty owner:
Mailing Address:
Phone:contractor:
Mailing Address:
Email Address:
Architectl Phone
Mailing Address:
Email Address:
Phone:Engineer
Mailing Address:
Email Address:
Manufactured Home lnstaller:
Mailing Address:
Email Address! '
Phone: (
PROJECT DETAILS
Sub. Lot
-
Block
-
Owner's Valuation of Work:
Sq. Ft. of Building: Height:
Describe Work:
lan t
# of Floors:-
Assessor's Parcel N umber:
Job Address:
Property Size (5q. Ft. or Acres):
AdditionRemodel/AlterationNewClass of Work:
DetachedAttachedGarage:
PROJECT DETAITS CONTINUED
Community
Natural Gas Propane Electric Other
Permit #:
NOTICE
Authoritv. This application fo r a Building Pernrit rnust be signed by the owner of the property, described above,
oranauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedby
the Owner, must be provided with this Application.
Lesal 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, (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.
CERTIFICATION
I hereby certify that I have read thisApplication and thatthe information contained above istrue 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 siibmittals and approvai of tiris Appiication, a Buiiciing Permit wiii be issueci 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)). AII 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 facilitv(iesl. described above, are not in compliance with Count'; Regulaticn{s) cr- an.r, 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 inspections of the work by the Building Division do not constitute an
acceptance of responsibility or liability bythe County of errors, omissions, or discrepancies. Asthe Owner, I
acknowledge that responsibilityfor 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 required information which is correct and accurate to the best of my knowledge.
oslZ?l zo.t-S
Property Owner Print and Sign Date
pt
Septic:
Type of Heat:
Driveway
Permit:
OFFICIAL USE ONtY
Special Conditions:
Adjusted Valuation
lu) tn
Check Fee:lePlan
N\
Permit Fee:^aillfyl.*"'Manu,"Home Fee
N1 ln Misc..Fees:
k\ l,x
Total Fee$: -c/oD"*o ffiPr,.oo
Balance Due:sg5. eo BP No:'mtr-9:lto4 oWtS No:
ll$ tn
Setbacks: -\)IR lOCC Grouo:ffi't,'"5flr,":'#b\
BUILDING / PLANNING DIVISION
Signed Approval Date