HomeMy WebLinkAboutApplication.pdfGarfield County
_ Community Development Department
• j il J 108 8th Street, Suite 401
eras :- Glenwood Springs, CO 81601
Li Li (970) 945 -8212
II. `; www,garfield- county.com
TYPE OF CONSTRUCTION
A. Commercial /Multi - Family
❑ Manufactured Home (SF or Duplex)
❑ Residential (SF, Duplex, or Townhome)
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BUILDING PERMIT
APPLICATION
A. Demolition
❑ Reroof
INVOLVED PARTIES _
Property Owner: a rb371 c2 K1 ,() ((f., Phone: 977) 95l : ,Ro /
Mailing Address: •P. C� ` C[,z„N . J tit s` j ,„f— . c� -' o:3 1
Contractor: Phone: ( )
Mailing Address:
Architect: Phone: (
Mailing Address:
Engineer: Phone: (
Mailing Address:
Manufactured Home Installer: Phone: (
Mailing Address:
• PROJECT NAME AND LOCATION
Describe Work: %` 2 N IV ok 17i T d X �-Sr f - V(-)r_-
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Job Address: j :' A (2 65. 0 / 5 G /a n) woC). pie/ %a , CC) I /6,0/
Assessor's Parcel Number ' iSC7 /��`�Sub. Lot Block
• Owner's Valuation of Work: $ 4,:21,?C'A, , ' U?titz� 00 Property Size (Sq.Ft or Acres): ' ') L-' C'
Sq.Ft of Building: J 01, '% / C? Height�4' �=f�c c . 30 # of Floors: /
Class of Work: 1 ❑ New I ❑ Alteration s ❑ Addition 1 ❑ Repair 1 Move /Relocation
Garage: ` ❑ Attached 0 Detached
Septic: ❑ ISDS ❑ Community
Type of Heat; ❑ Natural Gas I ❑ Propane ❑ Electric
Driveway Permit: 0 Exempt
❑ Permit it
0 Other
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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
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Legal Access. A Building Permit cannot be issued without proof of legal and adequate access to the property for
purposes ��|n�yecbonsbythe�ui|din����skun
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Other Permits. Multiple separate permlts 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 Watewater 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 commencenient.
CERTIFICATION�
1 hereby certify that 1 have read this Application and that the informatiori con ainodaboveisuneaodcurmct. |
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 af the Buliding Permit, 1 agree that 1 and my agerlts 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)), t 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(les), 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. |
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 ef this Application, including submittals, arid 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 | have read and understand the Notice and Certification above as we | as
have provided the required information which is correct and accurate to the best of my knowledge.
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Prop rty Owner Print and Sign
Date
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Special Conditions:
Adjusted Valuation:
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plan Check Fee:
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Permit Fee:
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Balance Due:
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