HomeMy WebLinkAboutApplication.pdfc::E' Garfwld County Community Development Department 108 8th Street, Suite 401 Glenwood Springs, CO 81601 (970) 945-8212 www_garfield-county_com , , ,TYPE 'OF't QNSTR,9CTION , '. ii
, • I' ". ' );,~t··;i "t'CI",,"'~,:Jr.{ . ··:t, , ,.,' " .-.'~J, . 0 Commercial/Mu lti-Fam ily I I2l. Demolition 0 Manufactured Home (SF or Duplex) )2iI; Residential (SF, Duplex, or
Townhome) 10 Reroof INVOLVED PARTIES .' , , .. ? , Property Owner: JIV'! AA1(..A Y::AN<'f.I-, l-LC Phone: (~4~ ) S 1:'-~33 Mail ing Address: 39'1> louN"f1l J2-D-I ~b, G.-~(A.>coD S1"6-5.,
CO ~ l bOl Contractor: £1')1.\) <'--r\;'jl.o'\ L ~\?~ c.U ""tS-Phone: ( cf"1~ ) ;1,,9 -S':S"'"l.. Mailing Address: l.j 1';6 ea.,,,, ~ r:'D_ IS'-/J (,..lkNwoob 'S~, (.0 'il l hoi Architect:
1J{I't Phone: ( _ ) Mailing Address: Engineer: f.-JL~ Phone: ( _ I Mailing Address: Manufactured Home Installer: "'f A-Phone: ( _ ) Mailing Address: PROJECf NAM ~ AND.LOCATION : "; "
' . " .. .....:"'., . ) , 'i"~ Describe Work: l"'TEe ,el' t::>J:Mo t*' FINIS fh;SI 0\ 5 iN t.-1S, ':;1)(1'\1 ~t..~ ANt> e-rHu. A4£.sSo~£> ,0 "'·/..LbW F0~ f/-f;moo [. L--Job Address:
3'1" U:>JN1'1 120 I?b, C-t.fNW ClOD -::'1'&->, c..o ~ I (".() I Assessor's Parcel Number: ~ 1~' 3 ~bo o4 'I Sub, -lot -=--Block~ Owner's Valuation of Work: $ 4, ""SO Property Size (Sq
.Ft or Acres): £'30 Sq.Ft of Building: < '11:.00 Height: :::::: ?. ~ I # of Floors: .~ Class of Work: o New I ~ A lte ra tio n I 0 Addition o Repair I 0 Move/Relocation Garage: o Attached
N/A o Detached Septic: )lS(.ISDS o Community Type of Heat: o Natural Gas I 0 Propane I J8I Electric I 0 Other Driveway Permit: o Exempt o Permit #:
Authoritv. 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 ISDS 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. I hereby
that I have read this Application and that the information contained above is true and correct. 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 submitta Is 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, ISOS 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, 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 required information which is correct and accurate to the best of my knowledge.
1/I~ !, l:> Property Owner Print and Sign Date Special Conditions: .J:)e;#tJ ~,I?fll~d h f'y/.kri!tJ;'1 k "ei'I4~ftJU . Adjusted Valuation: Fees: TotalFee~ 2.5 Balance -Setbacks: OCC
Group: Const Type: Lee j/~. ~ BUILDING /PLANNING DIVISION: p ,. .-~ & 7 ~ Signed Approval I ; Oate