HomeMy WebLinkAboutApplication.pdfGARFIELD COUNTY BUILDING PERMIT APPLICATION
108 81h Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970 -945 -8212 / Fax: 970- 384 -3470 / Inspection Line: 888 -868 -5306
www.car(ic Id- county.conl
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Parcel No: (this information is available at the assessors office 970 -945 -9134) t,5/4, /j/,
a361315400ag3 4,0
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Job Address: (if an address has not been assigned, please provide Cr, Hwy or Street Name & City) or and legal description
343 Coon+1,, Rocs -d 1 12 Car bondLt. Le_ Co ,S1 ba 3
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Lot No: ,,.,r Block No: Subd./ Exemption:
S a a Ha-checl 'Lk r (i
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Owner: (property owner)
34- cooni- tiR0 act LAC
MaiIin Address:
Pa•13c»c11-42 Ca.rba- la Li.
Ph:
970-ai63-118a
Alt Ph;
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ntractor:
arch L_a.l -e_ Cif -uctiaV
Mailin Address:
P O O L l77 (af bcDne-a 1L
Ph:
COO g b 3 i 1
Alt Ph:
6
Architect / Engineer:
Mailing Address:
Ph:
Alt Ph:
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Sq. Ft. of Building:
Sq. Ft. or Acres of Lot:
Height:
No. of Floors:
8
Use of Building:
9
Describe Work:
repir 1 fi
a i r�
10
Class of Work:
❑ New ❑ Alteration ❑ Addition
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Garage:
❑ Attached ❑ Detached
Driveway Permit:
Septic:
n ISDS ❑ Community
Owners vatuati of Work: $
I "2- L'} C)
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Authority.
This application for a Building Permit must be signed by
letter of authority, signed by the Owner, must be provided
A Building Permit cannot be issued without proof of legal
NOTICE /
the Owner of the property, described above, or an authorized agent. If the signature below is not that of the Owner, a separate
with this Application.
and adequate access to the property for purposes of inspections by the Building Department.
Electrical Permit, (2) County [SOS Permit, (3) another permit required for use on the property identified above, e.g. State or
Discharge Permit.
authorized is not commenced within 180 days of the date of issuance and if work is suspended or abandoned for a period of 180
CERTIFICATION
contained above is true and correct 1 understand that the Building Department accepts the Application, along with the plans
based upon my certification as to accuracy.
a Building Permit will be issued granting permission to me, as Owner, to construct the structure(s) and facilities detailed on
and my agents will comply with provisions of any federal, state or local law regulating the work and the. Garfield County Building
Regulation(s)). 1 acknowledge that the Building Permit may be suspended or revoked, upon notice from the Cotmty, if the location,
are not in compliance with County Regulation(s) or any other applicable law.
described above, to inspect the work. I further acknowledge that the issuance of the Building Permit does not prevent the
if any, discovered after issuance; or (2) stopping construction or use of the structure(s) or facility(ies) if such is in violation
work by the Building Department do not constitute an acceptance of responsibility ar liability by the County of errors, omissions
compliance with federal, state and local laws and County Regulations rest with me and my authorized agents, including without
THE NOTICE & CERTIFICATION ABOVE:
Leal Access.
Other Permits. Multiple separate permits may be required: (1) State
County Highway/ Road Access or a State Wastewater
Void Permit. A Building Permit becomes null and void if the work
days after commencement.
I hereby certify that I have read this Application and that the information
and specifications and other data submitted by me or on my behalf (submittals),
Assuming completeness of the submittals and approval of this Application,
the submittals reviewed by the Building Department.
In consideration of the issuance of the Building Permit, 1 agree that I
Code, ISDS regulations and applicable land use regulations (County
construction or use of the structure(s) and facility(ies), described above,
I hereby grant permission to the Building Department to enter the property,
Building Official from (1) requiring the correction of errors in the submittals,
of County Regulation(s) or any other applicable law.
Review of this Application, including submittals, and inspections of the
or discrepancies. As the Owner, I acknowledge that responsibility for
limitation my architect designer, engineer and/ or builder.
I HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND
)tt"S (oufr7/ IILCC
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OWNIGRS SIGN ■ JJ DATE
t_It c� - r V
Cush -' 10(' /
STAFF USE ONLY
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Special Conditions:
Adjusted Valuation:
k DO0.
Plan Check Fee:
Permit Fee:
No.--
Manu home Fee:
—.
Misc Fees:
ISDS Fee:
Total Fees:
1
{ Fees Paid:
[Group:
Balance Due:
BP No & Issue Date:
ISDS No & issued Date:
�J1
Setbacks:
OCC
Const Type:
Zoning:
BLDG DEPT:
PLNG DEPT:
AP VA D DATE
APPROVAL DATE