HomeMy WebLinkAboutApplication.pdf108 8" Street, Suite 401, Glenwood Springs, CO 81601 T (
Ph:970- 945 -8212 Fx:970- 384 -3440 Inspection Line: 888- 868 -530 . o
wv (�� �er
w t. .gar 4 19k, o
BUILDING PERMIT APPLICATION
1
Parcel No: (this information is available at the assessors office 970-945- 9134)
2- 3j3y5i 00053 3
Lot No: Block No: Subd./ Exempti (-, �2 V
see ak-A.chei4I aj ‹...f.--6,
ti
2
Job Address: Wan address has not been assigned, please provide CR, IIWYorStreet Name & City) or and legal doicription
2343 Coors YEtxx i )12 Cayloon Uj( . CO d )02-R 6'
3
Owner: (properly owner)
2 3 3 Cox-ti—ft R e a d
Mailing Address:
P. c., go c► 422 ca_ronciell
Ph:
G 70 112.3 1 l 8{
Alt Ph:
4
Contractor:
Racial (Lake_ CDns}ya J.LLC
Mailin Address:
Po. tx 1 L122. Ca i -va 14
Ph:
0170 q 63 f 18Y
Alt Ph:
5
Manufactured home installer:
x114\
Mailing Address:
Ph:
Lic #:
6
Architect:
Iii lot
Mailing Address:
Ph:
Alt Ph:
7
Enng veer:
ri "t
Mailing Address:
Ph:
Alt Ph:
g
Sq. Ft. of Building:
Sq. Ft. or Acres of Lot:
-
Height:
-
No. of Floors:
9
Use of Building:
'd tial ❑Commercial DOther
Class of Work:
DNew ❑Alteration :Addition ❑Repair YII)emo ❑Move
10
Describe Wor
c erYj eXMS'hn hQ.)Se.
11
Garage: _�
❑Attached ❑Detached
ptic:
IISISDS :Community
Type ofHeat:
❑Nat. Gas Propane DElectric DOther
12
Driveway Permit:
Owners va atilt t of Work:
oll
NOTICE
Authority. This application fora Building Pennit 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 Department.
Other Permits. Multiple separate permits may be required: (1) State Electrical Permit, (2) County ISDS Permit, (3) another permit required for use on the property identified above, e.g. State or
County Highwayl 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 Department 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 Department.
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, ISDS regulations and applicable land use regulations (County Regulation(s)), I acknowledge that the Building Permit may be suspended or revoked, upon notice from the County, i ftlte 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.
hereby grant permission to the Building Department to enter the property, described above, to inspect the work. 1 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 Department 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 AVE READ AND UNDERSTAND THE NOTICE & CERTIFICATION ABOVE:
:.3y3Ceti -ry'a. LLC
i iT5 ti-/ knuai r?/i
(Of/NV[ S SI I NATURE DATE
STAFF USE ONLY
Special Conditions:
Adjusted Valuation:
5(,0.-
Plan Check Fee:
Permit Fee:
oa—
Manu home Fee:
--
Misc Fees:
Total Fees:
DS.—
r,ees Paid:
d)).—
Balance Due:
BP No & issue Date:
iSDS No & issued Date:
10 -2*11
Setbacks:
OCC Group.
Const Type:
Zoning:
BLDG DEPT; (1 3 - 13
�!
PLNG DEPT:
APPROVAL DATE
APPROVAL DATE