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Application Form
�� Garfield County
RECEINgPmunity Development Department
10118`r' Street, Suite 401
DEC 0 -�-��r'Glenwood Springs, CO 81601
GARFIELD COUNTY (970) 945-8212
,()M UNITY DEVELOPMN-Barfield-coup .corn
TYPE OF CONSTRUCTION
[:*j Commercial/Multi-Family
Q Manufactured Home or Tiny Home (Single or Multi -Level)
0 Residential (SF, Duplex or Townhome)
0 Accessory Dwel!ing Unit (ADU) - MAXIMUM SIZE OF 1,200 SQUARE FEET
INVOLVED PARTIES
Property Owner: Blue Mind LLC Phone:..(,9LLf
19
Mailing AddrPcc. 5190 Upper Cattle Creek Road; Carbondale, CO 81623
Email Address: Sheldon@coloradoextreme.org
Demolition
Reroof
349-2980
Contractor: Javier Martinez Phone: 91 70 .) 379-7398
Mailing Address:
Email Address:
Architect: Losberger De Boer Phone: (. 60 220-7113
Mailing Address: -285 Bucheimer RD, Suite A; Frederick, MD 21701
Fmnil AddrPcc, Mike.Morse@losbergerdeboer.com
I
f"
Engineer: Phone: ( )
l Mailing Address:
Email Address:
Manufactured Home Installer:
Mailing Address:
Email Address:
PROJECIr DETAILS
Phone: ( )
Describe Work: Temporary installation of donated warming but (20' x 50') to be operated December -March
Job address: 2340 100 County Road, Carbondale, CO 81623
Assessor's Parcel Number: 239336400278
Sub. Lot Block
Owner's valuation of Work: $ $7,000 Property Size (Sq. Ft. or Acres): 69.749
Sq. Ft. of Building: 1,000 SF Height: I 11-711# of Floors: 1
r Class of Work: :New ❑Remodel/Alteration ❑Addition
G Garage: ❑Attached — ❑ Detached
Colorado Extreme I Am - led, Land Use Change Permit Application
2
DHMDESIGN.COM
PROJECT DETAILS CONTINUED
Septic: OWTS Community
Type of Heat: ❑Natural Gas I ropane ❑ Electric ❑ Other
Driveway +❑Exempt ❑ Permit #: GRB 23-D-8
Permit:
NOTICE _
Authority. This application for a Building Permit must be signed by the Owner of the property, described above,
or an authorized agent. If the signature below 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, (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 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 submittals reviewed by the Building Division. In
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)). 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 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 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.
I hereby acknowledge that I have read and understand the Notice and Certification above, as well as, have
provided the r ired information which is correct and accurate to the best of my knowledge.
Sub„w,, l 12/3/25
Property Owner Print and Sign Date
OFFICIAL USE ONLY
Special Conditions:
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Adjusted Valuation:
Plank Fee:
Per it Fee: rt
Manu. Home Fee:
Misc. Fees:
To I Fees: ,�
Fea Paid: �j
Balance Due:
BP No:
OWTS No:
Setbacks:
OCC Group:
ConrType:zoning:
BUILDING / PLANNING DIVISION
Signed vaI Date
Colorado Extreme I Amended Land Use Change Permit Application