HomeMy WebLinkAboutApplication.pdfCommunity Development Department
108 8 th Street, Suite 401
Glenwood Springs, CO 81601
(970) 945-8212
www.garfiel d-county.com
TYPE OF CONSTRUCTION
D Commercial/Multi-Fami ly
D Manufactured Home (SF or Duplex)
D Resi dential (SF, Duplex, or Town home)
I D Demolition
I ~ Reroof
rl_N_VO_L_V_E _D _PA_R_T_IE~S -----------------.f.tBS~9/~-3
Property Owner: --==...!....:::~=..:~~~~~4---....-----Phone : (2lc2_)~~~· ~--__j
Mailing Address : -==----L--'-L..L.L..:=...:.."-L.~...J-J~..J,....1...~-i.....i...~'....l.<lo<J"4-....o...l...d<l..s..<l.-~.d...l;.<~-L.::.==1JL~.l...J\V
Architect: -..,.-'f-b'c:----------------Phone: ( __ -------
Mailing Address :--+---------------------------
Engineer: ----if----------------Phone:( ________ _
Mailing Address :-+----------------------------
Manufactured Ho e Installer: Phone: ( --------------------
Mailing Address:----------------------------
PROJECT NAME AND LOCATION
Job Address : ~
~
Assessor's Parcel Number: .;J.I JC,-Qo l··co:Clt:i ?ub. _____ --____ Lot __ .---_ Block -=-
Owner's Valuation of Work: $ 58' . .3?, (0 <-f.. Property Size (Sq.Ft or Acres): -----------1
Sq.Ft of Building: -'-'I 0: ....... :?0""'"""'-----Height:--------#of Floors:_---'-----
Class of Work: D New D Alteration D Addition epair D Move/Relocation
Garage: D Attached D Detached
Septic : 0 ISDS D Community
Type of Heat: D Natural Gas D Propane D Electric D Other
Driveway Permit: D Exempt D Permit#: _______ _
NOTICE
I Authority: This app li catio n f?r a Building Pe rmit must be signed by th e Owner of the property, desc ribed above, or
an authorized agent. If the sign ature below is not t hat of the Owner, a se parate letter of authority, signed by the
Owner, must be pr ovided with this Application .
Legal Access. A Building Permit cannot be issued without proof of legal and adequate access t o the property for
purposes of inspections by the Building Division.
Other Permits. Multiple se parate 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 Acces s or a
St ate Wastewater Di sc harge 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 suspen ded or abandoned for a period of 180 days after commencement.
CERTIFICATION
I hereby certify that I have read this App lication and that the information conta i ned above is true and correct.
understand that the Building Divi sion 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 Perm it will be issued grant ing
permission to me, as Owner, to construct the structure(s) and facilities detail ed 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 Garfiel d County Bu ilding Code, ISDS
regulations and applica ble land use regulation s (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 st ructure(s)
and facility(ies), described above, are not in compliance with County Regulation(s) or any other app licable 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 corr ec tion of errors in the submittals, if any, discovered after issuance; or (2) st opping construction
or use of the structure(s) or facility(ies) if such is in violation of County Regulation(s) or any other applicable l aw.
Review of this Application, including submittals, and inspections of th e work by the Building Division do not
constitute an acceptance of responsibility or liability by the County of erro rs, omissions or disc repancie s. As the
Owner, I acknowledge that responsibility for compliance with federal, state and loca l laws and County Regulation s
rest with me and my au tho rized agents, including without limitation my architect designer, engineer and/ or
j 41~ ~ fuYI 0A, v,iiQ ~ -w;;;I _s f-Oii/u'-f1 fr> p~c//u;~
0 i hereby acknowledge that I ~a~e' re~~a]d understand the Notice and Certification ab b've as well as f ~ ·
builder.
have provided the required information which is correct and accurate to the best of my knowledge.
bo.rle.. Jetuc.lL-1 ?{ u £J(J11~i L ceQ J --=(_o=-+-~l-~-+->l__.I.___ __ _
Property Owne~d Sign Date
OFFICIAL USE ONLY
Special Conditions:
Adjusted Valuation: Plan Check Fee: Permit Fee:
(j, /() 'oo_
Manu home Fee:
Total Fees: OO ~100.----~es Paid~ Balance o0:
~C>.~
BP No :
Setbacks: OCCGroup:
BUILDING/ PlANNING DIVISION ,&J_flW~
Signed Approval
Mi sc Fees:
Date