HomeMy WebLinkAboutApplication.pdfGARFIELD COUNTY BUILDING PERMIT APPLICATION
108 8th Street, Suite 401, Glenwood Springs, Co 81601
Phone: 970-945-8212 / Fax: 970-384-3470 / Inspection Line: 970-384-5 1CEIVE
www.oarfield-countv.cam
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Parcel o: tmhis inforation is available t the assessors office 970-945-9134) JUL 2 1 201
3 'S-0330-3-Dd
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Job Address: (if an address has not been assigned, please rovide Cr, H or Street Name & City) or and legal descriptio
COUNTY
zez MF p/".4c aa-t,yfr/f Le.MMUNIIY DEVELOPMEN1
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Lot No: Block No: Subd./ Exemption:
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Owner: Nrtyowner)
611a.Atesf
MailingA9iddress:
2232 Amer Pe d0 i eejq
Ph:
371 r 1/ 5-Ce
Alt Ph;
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Co rp clor:
RifrA/.7J l'AS 'ot/ Rezi % J
Mailing Address:
?o $bX' 2Z 3 5;11- CO
Phi/z6--S-C140Alt
Ph:
(ot8'itoSir-
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Architect / Engineer:
Mailing Address: '
Ph:
Alt Ph:
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Sq. Ft. of Building:
Sq. Ft. or Acres of Lot:
Height:
No. of Floors:
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Use of Building: g t
/le siDZiN[e,.....
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Describe Work: ���( - oP� rob (' i- 0-w i s1&Jd�, 33rs.h's��.���Jk.$ i ue44--
y
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Class of Work:
o New ,Alteration o Addition
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Garage:
o Attached o Detached
Septic:
o ISDS o Community
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Driveway Permit:
Owners valuation of Work: 1iiL>/o4.p300
Authority.
This application for a Building Permit must
letter of authority, signed by the Owner,
A Building Permit cannot be issued
NOTICE
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
must be provided with this Application.
without proof of legal and adequate access to the property for purposes of inspections by the Building Department.
(1) State Electrical Permit, (2) County ISDS Permit, (3) another permit required for use on the property identified above, e.g. State or
a State Wastewater Discharge Permit.
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
CERTIFICATION
that the information contained above is true and correct. I understand that the Building Department accepts the Application, along with the plans
on my behalf (submittals), based upon my certification as to accuracy.
of this Application, a Building Permit will be issued granting permission to me, as Owner, to construct the structure(s) and facilities detailed on
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
(County Regulation(s)). I acknowledge that the Building Permit may be suspended or revoked, upon notice from the County, if the location,
described above, are not in compliance with County Regulation(s) or any other applicable law.
to enter the property, described above, to inspect the work. I further acknowledge that the issuance of.the Building Permit does not prevent the
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
inspections of the work by the Building Department do not constitute an acceptance of responsibility or liability by the County of errors, omissions
responsibility for compliance with federal, state and local laws and County Regulations rest with me and my authorized agents, including without
]der.
XD AND UNDERSTAND THE NOTICE & CERTIFICATION ABOVE:
DATE L 2 i I l>/
Legal Access.
Other Permits. Multiple separate permits may be required:
County Highway/ Road Access or
Void Permit A Building Permit becomes null and
days after commencement.
I hereby certify that I have read this Application and
and specifications and other data submitted by me or
Assuming completeness of the submittals and approval
the submittals reviewed by the Building Department.
In consideration of the issuance of the Building Permit,
Code, ISDS regulations and applicable land use regulations
construction or use of the structure(s) and facility(ies),
I hereby grant permission to the Building Department
Building Official from: (1) requiring the correction of
of County Regulation(s) or any other applicable law.
Review of this Application, including submittals, and
or discrepancies. As the Owner, I acknowledge that
limitation my architect designer, engineer and/ or b
I HEREBY ACKNOWLEDGETH T I HAV R
OWNERS SIGNATU /(
STAFF USE ONLY
Special Conditions:
Adjusted Valuation:
Plan Check Fee:
Permit Fee:
Manu home Fee:
Misc Fees:
ISDS Fee:
Total Fees:
100 ' 00
Fees Paid:
[00 . 00
Balance Due:
-�`�
BP No & Issue Date:
ISDS No & Issued Date:
PbbF - 3311
- .
Setbacks:
---.�
OCC Group:
Const Type:
Zoning:
1�
BLDG DEPT:
/
0 -1--1-- 14 -
PLNG DEPT:
APPROVAL DATE
APPROVAL DATE