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munity Development Department
108 8th Street, Suite 401
Glenwood Springs, CO 81501
le7ol94s-82t2
www.garfield countyco,Bov
Gurfield County
BUILDING PERMIT
APPLICATION
TVP iOF CONSTRUCTION
Commercial/M u lti-Family Demolition
Manufactured Home (Single or Multi-Level)I Gas Pi
Residential (SF, Duplex orTownhome)Reroof
Accessory Dwelling Unit (ADU) - MAXIMUM SIZE OF 1,200 SQUARE FEET
INVOLVED PARTIES
Property owner: /l pAo p? LtSSot-c phone: ftio ,4sl- i41
Mailing Address:,t/1_ dcunT-? Fo*L f)/<.r itf Za
Email Address:ZA);V?L1S@ 747tF ..co A,/\
Contractorl 9l:tr=Phone: (_)
Mailing Address
Email Address:
PROJECT DETAILS
Describe Work:Zgt-naaTtorJ o€ PRo v[ rANJK
Job Address:;11 Lo,.trtTl AoAh 225
Assessor's Parcel Number
Sub,
064.1 o O g'
Lot Block _
Gas Pipe Length/ Diameter:
Appliances Serviced By Gas Line (list all, include BTU):f wfultr't-{0 J1?
O l^,,/\ f[11 ]tAI-/r o cD\
Class of Work:
Xalteration Addition
Type of Heat:ural Gas f,fo,oo,n"
NOTICE
Authority. ThisappiicationforaBuiidingPermitmusibesignedbytheOwneroftheproperiy,describeciabove,
oranauthorizedagent. lfthesignaturebelowisnotthatoftheOwner,aseparateletterofauthority,signedby
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.
O:lhef-flefmits. 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.
V-s.iidlgni!=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.
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as,
have on which is correct and accurate to the bFst of my knowledge.
7 /n lto75 -
Propcrty Owner and Sign Date
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 Applicatiorr, alorrg with tlre plarrs and specifications arrd otlrer
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, OWTS regulations and applicable land use regulations (County Regulation(s)). I acknowledge that the
Rr rildino Dormii merr ha <r rcnondor{ nr rarrnlzar'l r rnnn nniina frnm iho l'nr rnirr if tha lnrrtinn .^ncirr r.fi^h ^r r rc6
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 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. Rer.riew of this A.pplication, !nc!uding submittals, and inspections of the work byr 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
designer, engineer and/ or builder.
OFFICIAT UsE ON Oos
Special Conditions:I
Adiusted Valuation:
N/A
Permit Fee:
Slnn.@
Fees:Mise ..N/A
Total Feesr
$/on,oo
Fees Paid:
'i/nn.n"
**2ilua BP No:
ClFPn -9Un A lf'or
BUTLDTNG / PLANNTNG DrVrSrON :
Signed Approval
a 7
Date